Provider Demographics
NPI:1427440965
Name:LANGE, JOHANNA MARIE (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MARIE
Last Name:LANGE
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:HANNA
Other - Middle Name:
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:608 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:BALLINGER
Mailing Address - State:TX
Mailing Address - Zip Code:76821-2406
Mailing Address - Country:US
Mailing Address - Phone:325-365-2531
Mailing Address - Fax:
Practice Address - Street 1:608 AVENUE B
Practice Address - Street 2:
Practice Address - City:BALLINGER
Practice Address - State:TX
Practice Address - Zip Code:76821-2406
Practice Address - Country:US
Practice Address - Phone:325-365-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1255417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist