Provider Demographics
NPI:1821420803
Name:LANG, BRYAN (DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:LANG
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 NW LOVEJOY ST
Mailing Address - Street 2:S205
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2859
Mailing Address - Country:US
Mailing Address - Phone:503-223-1856
Mailing Address - Fax:503-223-1765
Practice Address - Street 1:2525 NW LOVEJOY ST
Practice Address - Street 2:205
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2859
Practice Address - Country:US
Practice Address - Phone:503-223-1856
Practice Address - Fax:503-223-1765
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1497172373OtherGROUP NPI