Provider Demographics
NPI:1972292100
Name:LANG, STEPHANIE R (PTA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:LANG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-6503
Mailing Address - Country:US
Mailing Address - Phone:580-223-3383
Mailing Address - Fax:580-223-6696
Practice Address - Street 1:1 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-7036
Practice Address - Country:US
Practice Address - Phone:580-223-3383
Practice Address - Fax:580-223-6696
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2199225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant