Provider Demographics
NPI:1487150504
Name:LANGE, GINA M (PT, DPT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:LANGE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BELOIT HEALTH SYSTEM INC
Mailing Address - Street 2:1969 W HART ROAD
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2230
Mailing Address - Country:US
Mailing Address - Phone:608-364-2293
Mailing Address - Fax:608-364-5525
Practice Address - Street 1:OCCUPATIONAL HEALTH SPORTS CLINIC
Practice Address - Street 2:1650 LEE LANE
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-3945
Practice Address - Country:US
Practice Address - Phone:608-364-4666
Practice Address - Fax:608-364-4670
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist