Provider Demographics
NPI:1528707148
Name:LANG, KATHLEEN MARGARET
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARGARET
Last Name:LANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3977 PARK CIRCLE LN APT C
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6763
Mailing Address - Country:US
Mailing Address - Phone:916-717-3833
Mailing Address - Fax:
Practice Address - Street 1:1535 RIVER PARK DR STE 1000
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4601
Practice Address - Country:US
Practice Address - Phone:916-734-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist