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NPI Code Detail

MEDICARE: CHE' NICOLE LANG PTA

MEDICARE: CHE' NICOLE LANG PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant160.009013IL

General Provider Information

NPI Number : 1093314429
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHE' NICOLE LANG PTA
Provider Business Mailing Address
First Line : 212 W SAINT CLAIR ST
Second Line :
City : FREEBURG
State : IL
Zip : 62243-1136
Country : US
Telephone Number : 618-402-4599
Fax Number :
Provider Business Practice Location Address
First Line : 1021 W E ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62220-1055
Country : US
Telephone Number : 618-233-2095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2020
Last Update Date : 10/16/2020

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Directions to “ CHE' NICOLE LANG PTA” Practice Location

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