Provider Demographics
NPI:1902267545
Name:LANG, MELISSA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:GO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:171 SANFORD ST
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:885 BROOKDALE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-3910
Practice Address - Country:US
Practice Address - Phone:510-861-3884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist