Healthcare Provider Details

I. General information

NPI: 1215827217
Provider Name (Legal Business Name): KYLIE M LANGE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 SPRUCE ST
TOWER MN
55790-5601
US

IV. Provider business mailing address

1939 MINNEHAHA AVE W STE 300
SAINT PAUL MN
55104-1033
US

V. Phone/Fax

Practice location:
  • Phone: 218-481-7603
  • Fax: 218-481-7601
Mailing address:
  • Phone: 651-748-4338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14054
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: