Healthcare Provider Details

I. General information

NPI: 1366401358
Provider Name (Legal Business Name): CHRISTOPHER DANIEL LANGE ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF NEVADA CASHELL FIELDHOUSE MS 265
RENO NV
89557-0001
US

IV. Provider business mailing address

UNIVERSITY OF NEVADA CASHELL FIELDHOUSE MS 265
RENO NV
89557-0001
US

V. Phone/Fax

Practice location:
  • Phone: 775-745-7466
  • Fax: 775-784-8077
Mailing address:
  • Phone: 775-745-7466
  • Fax: 775-784-8077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0506035
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: