Individual
MR. MARK VINCENT LANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
FAIRFAX RD AT VIRGINIA ST, SLC, UT 84103
(801) 536-3616
Mailing address
FAIRFAX RD AT VIRGINIA ST, SLC, UT 84103
(801) 536-3616
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5611857-2401
UTAH STATE LICENSE
UT
Enumeration date
04/02/2010
Last updated
07/20/2021
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