Provider Demographics
NPI:1720337165
Name:LANG, ISAAC DOUGLAS KENNETH (DPT)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:DOUGLAS KENNETH
Last Name:LANG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25671 CARROL CT
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3725
Mailing Address - Country:US
Mailing Address - Phone:509-540-6812
Mailing Address - Fax:
Practice Address - Street 1:25671 CARROL CT
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3725
Practice Address - Country:US
Practice Address - Phone:509-540-6812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist