Individual
MRS. STACY GAYLE LANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
10457 SLATER AVE, 203, FOUNTAIN VALLEY, CA 92708-7710
(949) 521-1912
Mailing address
10457 SLATER AVE, 203, FOUNTAIN VALLEY, CA 92708-7710
(949) 521-1912
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT926
CA
Other
Enumeration date
02/09/2012
Last updated
02/09/2012
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