Healthcare Provider Details

I. General information

NPI: 1235730086
Provider Name (Legal Business Name): MEREDITH GAVIN LANGLEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 MAIN ST STE 3
BRYANT AR
72022-9201
US

IV. Provider business mailing address

5 CLOVER LEAF DR
GREENBRIER AR
72058-8056
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-0500
  • Fax:
Mailing address:
  • Phone: 501-303-8439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4893
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: