Provider Demographics
NPI:1114767456
Name:LANGE, ADAM DANIEL (RRT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:DANIEL
Last Name:LANGE
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10429 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-3625
Mailing Address - Country:US
Mailing Address - Phone:406-702-5103
Mailing Address - Fax:
Practice Address - Street 1:200 N OREGON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3624
Practice Address - Country:US
Practice Address - Phone:406-702-5103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRCP-RCP-LIC-9507227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered