MEDICARE: DANIELLE MARIE LANG ATC

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
1	2255A2300X	Athletic Trainer	224987	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	224987	OTHER	AK	ATHLETICTRAININGLICENSE

General Provider Information

NPI Number	:	1497247506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE MARIE LANG ATC

Provider Business Mailing Address
First Line	:	252 STEEPLE RIDGE DR
Second Line	:
City	:	CAMERON
State	:	NC
Zip	:	28326-6615
Country	:	US
Telephone Number	:	610-780-4405
Fax Number	:

Provider Business Practice Location Address
First Line	:	2518 QUARTERMASTER STREET
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311
Country	:	US
Telephone Number	:	610-780-4405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2018
Last Update Date	:	12/10/2025

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