MEDICARE: MS. MARINA LANG 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
1	225100000X	Physical Therapist	107067-0	TX

General Provider Information

NPI Number	:	1720254691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARINA LANG PT

Provider Business Mailing Address
First Line	:	7221 LAMB RD APT 1208
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1923
Country	:	US
Telephone Number	:	210-358-2620
Fax Number	:	210-358-4750

Provider Business Practice Location Address
First Line	:	7221 LAMB RD APT 1208
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1923
Country	:	US
Telephone Number	:	210-692-0765
Fax Number	:

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

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	05/01/2008

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