Provider Demographics
NPI:1740155621
Name:LANGE, MARY (LMT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:613 RESIDENZ PKWY APT D
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-6298
Mailing Address - Country:US
Mailing Address - Phone:937-239-7800
Mailing Address - Fax:
Practice Address - Street 1:145 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-2387
Practice Address - Country:US
Practice Address - Phone:937-433-4800
Practice Address - Fax:937-433-1694
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist