Provider Demographics
NPI:1760407506
Name:LANG, SUZANNE G (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:G
Last Name:LANG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:G
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1915 LENDEW ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7033
Mailing Address - Country:US
Mailing Address - Phone:336-275-4263
Mailing Address - Fax:336-275-3320
Practice Address - Street 1:1915 LENDEW ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7033
Practice Address - Country:US
Practice Address - Phone:336-275-7405
Practice Address - Fax:336-275-3320
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079CJOtherBCBS
NC7211476Medicaid
NCP000387276OtherMEDICARE RAILROAD
NC188629OtherMEDCOST
NC079CJOtherBCBS