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NPI Code Detail

MEDICARE: JESSICA LANGE PT

MEDICARE: JESSICA LANGE PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT011080OH

General Provider Information

NPI Number : 1295760312
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LANGE PT
Provider Business Mailing Address
First Line : 8 HARVARD DR
Second Line : DR
City : FT MITCHELL
State : KY
Zip : 41017-2835
Country : US
Telephone Number : 859-331-3424
Fax Number :
Provider Business Practice Location Address
First Line : 2915 CLIFTON AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45220-2402
Country : US
Telephone Number : 513-872-2000
Fax Number : 513-281-8842
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 07/08/2007

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Directions to “ JESSICA LANGE PT” Practice Location

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