Provider Demographics
NPI:1396297727
Name:LANG, KELDYN (PT)
Entity type:Individual
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First Name:KELDYN
Middle Name:
Last Name:LANG
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:1801 ORANGE TREE LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4589
Mailing Address - Country:US
Mailing Address - Phone:909-557-1607
Mailing Address - Fax:909-557-1732
Practice Address - Street 1:8805 HAVEN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5149
Practice Address - Country:US
Practice Address - Phone:909-912-1750
Practice Address - Fax:909-557-1732
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPT2920042251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic