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General NPI Number Information
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NPI Number | 1619779618
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Entity Type | Organization
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Legal Business Name | LANGE SPORTS MEDICINE AND PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 11012 VENTURA BLVD
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City | STUDIO CITY
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State | CA
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Zip | 91604-3546
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Country | US
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Telephone | 630-723-9949
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Fax |
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Provider Business Mailing Address
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Address Line | 12605 VENTURA BLVD # 1075
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City | STUDIO CITY
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State | CA
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Zip | 91604-2415
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY/OWNER
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Name | DYLAN LANGE
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Credential | PT, DPT
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Telephone | 630-723-9949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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