Healthcare Provider Details

I. General information

NPI: 1235828062
Provider Name (Legal Business Name): COLIN LANG PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 HACIENDA DR
VISTA CA
92081-6024
US

IV. Provider business mailing address

2120 E BAY DR NE
OLYMPIA WA
98506-3221
US

V. Phone/Fax

Practice location:
  • Phone: 760-295-4175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1235828062
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: