MEDICARE: INFORM PHYSICAL THERAPY AND WELLNESS LLC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1568352631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFORM PHYSICAL THERAPY AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	9808 BLUE SPRUCE DR
Second Line	:
City	:	SPRINGBORO
State	:	OH
Zip	:	45066-5010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8379 YANKEE ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-1810
Country	:	US
Telephone Number	:	513-324-1923
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	CHARLOTTE LANGE
Credential	:
Telephone Number	:	513-324-1923

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	07/08/2025

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