Healthcare Provider Details

I. General information

NPI: 1891083762
Provider Name (Legal Business Name): KATHRYN CLARE LANG PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN CLARE MORAN PT, DPT

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 WADE GREEN RD NW STE 140
KENNESAW GA
30144-1808
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 770-627-2364
  • Fax:
Mailing address:
  • Phone: 423-238-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11703
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number033906
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT010947
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: