MEDICARE: LANGE SPORTS MEDICINE AND PHYSICAL THERAPY

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
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1619779618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANGE SPORTS MEDICINE AND PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	12605 VENTURA BLVD # 1075
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2415
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4444 LANKERSHIM BLVD STE 108
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2346
Country	:	US
Telephone Number	:	630-749-7772
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF PHYSICAL THERAPY/OWNER
Name	:	DYLAN LANGE
Credential	:	PT, DPT
Telephone Number	:	630-723-9949

Provider Enumeration Date	:	03/27/2025
Last Update Date	:	04/09/2026

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