Provider Demographics
NPI:1720254691
Name:LANG, MARINA (PT)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7221 LAMB RD APT 1208
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1923
Mailing Address - Country:US
Mailing Address - Phone:210-358-2620
Mailing Address - Fax:210-358-4750
Practice Address - Street 1:7221 LAMB RD APT 1208
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1923
Practice Address - Country:US
Practice Address - Phone:210-692-0765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107067-0225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist