Provider Demographics
NPI:1851890834
Name:LANG, NAOMI MARIE
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:MARIE
Last Name:LANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 WOODLAND RAVINE DR.
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114
Mailing Address - Country:US
Mailing Address - Phone:810-287-0116
Mailing Address - Fax:
Practice Address - Street 1:6535 DRAKE RD. WEST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-592-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004020225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant