Provider Demographics
NPI:1861215006
Name:LANGE, REBECCA (LMT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 STERLING RANCH RD S
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-8546
Mailing Address - Country:US
Mailing Address - Phone:318-572-9164
Mailing Address - Fax:
Practice Address - Street 1:63 STERLING RANCH RD S
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-8546
Practice Address - Country:US
Practice Address - Phone:318-572-9164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10165225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist