Healthcare Provider Details

I. General information

NPI: 1528131828
Provider Name (Legal Business Name): JENNIFER E LANGELIERS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER E GREENWOOD PTA

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2612 EAGLE ST
ANCHORAGE AK
99503-2818
US

IV. Provider business mailing address

2612 EAGLE ST
ANCHORAGE AK
99503-2818
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-2118
  • Fax: 907-562-2128
Mailing address:
  • Phone: 907-562-2118
  • Fax: 907-562-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8411
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2678
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-558
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: