Healthcare Provider Details

I. General information

NPI: 1508440462
Provider Name (Legal Business Name): NAOMI LANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33129 BI STATE BLVD
LAUREL DE
19956-4539
US

IV. Provider business mailing address

33129 BI STATE BLVD
LAUREL DE
19956-4539
US

V. Phone/Fax

Practice location:
  • Phone: 410-422-3219
  • Fax:
Mailing address:
  • Phone: 410-422-3219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: