Provider Demographics
NPI:1497247506
Name:LANG, DANIELLE MARIE (ATC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:LANG
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4761 PLUM ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:FORT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-1402
Mailing Address - Country:US
Mailing Address - Phone:610-780-4405
Mailing Address - Fax:
Practice Address - Street 1:4076 NEELY ROAD
Practice Address - Street 2:UNIT 2
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99703-1402
Practice Address - Country:US
Practice Address - Phone:610-780-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2143OtherALABAMA BOARD OF ATHLETIC TRAINING