Provider Demographics
NPI:1952731762
Name:LANGE, THOMAS RICHARD (MPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:RICHARD
Last Name:LANGE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9570 SW 107TH AVE
Mailing Address - Street 2:SUITE 201C
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2788
Mailing Address - Country:US
Mailing Address - Phone:954-980-8364
Mailing Address - Fax:786-542-1142
Practice Address - Street 1:9570 SW 107TH AVE
Practice Address - Street 2:SUITE 201C
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2788
Practice Address - Country:US
Practice Address - Phone:954-980-8364
Practice Address - Fax:786-542-1142
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist