MEDICARE: GABRIELE H LANGAN 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	3848-024	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3948-024	OTHER	WI	PT

General Provider Information

NPI Number	:	1548458524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELE H LANGAN PT

Provider Business Mailing Address
First Line	:	600 HARTBROOK DR STE 111
Second Line	:
City	:	HARTLAND
State	:	WI
Zip	:	53029-1436
Country	:	US
Telephone Number	:	262-367-3110
Fax Number	:	262-367-3112

Provider Business Practice Location Address
First Line	:	600 HARTBROOK DR STE 111
Second Line	:
City	:	HARTLAND
State	:	WI
Zip	:	53029-1436
Country	:	US
Telephone Number	:	262-367-3110
Fax Number	:	262-367-3112

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

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	03/23/2022

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