Provider Demographics
NPI:1669798039
Name:LANGE, ALICE JEAN (LMT)
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:JEAN
Last Name:LANGE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28960 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2403
Mailing Address - Country:US
Mailing Address - Phone:727-485-3737
Mailing Address - Fax:
Practice Address - Street 1:291 BROOKSIDE CT
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5352
Practice Address - Country:US
Practice Address - Phone:727-485-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-10
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA33729225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist