Provider Demographics
NPI:1811196421
Name:LANG, KRISTIN M (MSPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:LANG
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7733 FORSYTH BLVD
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1817
Mailing Address - Country:US
Mailing Address - Phone:800-677-1202
Mailing Address - Fax:303-455-0596
Practice Address - Street 1:11800 W 49TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-2176
Practice Address - Country:US
Practice Address - Phone:303-463-1382
Practice Address - Fax:303-423-1609
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist