MEDICARE: MRS. MAGGIE JEAN LANG PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	01399	MO

General Provider Information

NPI Number	:	1528373099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAGGIE JEAN LANG PT

Provider Business Mailing Address
First Line	:	5709 KELLER BEND DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-3474
Country	:	US
Telephone Number	:	314-842-4073
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 ARNOLD MALL
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-2223
Country	:	US
Telephone Number	:	636-282-0125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	08/09/2010

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