Basic Information
| Provider Information | |||||||||
| NPI: | 1720387335 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANG | ||||||||
| FirstName: | NICOLLE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 733 CHAMPLAIN CT | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275196475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166596931 | ||||||||
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| Practice Location | |||||||||
| Address1: | 615 SPRING FOREST RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276099150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198768899 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2011 | ||||||||
| LastUpdateDate: | 03/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11270 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.