Provider Demographics
NPI:1750154134
Name:KANGE, ADRIAN ELINGE (PTA,CPT)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:ELINGE
Last Name:KANGE
Suffix:
Gender:M
Credentials:PTA,CPT
Other - Prefix:
Other - First Name:ADRIAN
Other - Middle Name:ELINGE
Other - Last Name:KANGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA,CPT
Mailing Address - Street 1:N168W21850 MAIN ST APT 39
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WI
Mailing Address - Zip Code:53037-9395
Mailing Address - Country:US
Mailing Address - Phone:612-242-6173
Mailing Address - Fax:
Practice Address - Street 1:1300 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-4415
Practice Address - Country:US
Practice Address - Phone:414-228-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA2871225200000X
WI4061225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant