Provider Demographics
NPI:1689882912
Name:LANG, AMANDA MELANIE (LPTA)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MELANIE
Last Name:LANG
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2168 BUNTS RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107
Mailing Address - Country:US
Mailing Address - Phone:216-288-3674
Mailing Address - Fax:
Practice Address - Street 1:4511 ROCKSIDE RD SUITE #330
Practice Address - Street 2:SUPPLEMENTAL HEALTH CARE
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44132
Practice Address - Country:US
Practice Address - Phone:216-901-0400
Practice Address - Fax:216-901-0401
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5565225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant