Healthcare Provider Details

I. General information

NPI: 1710033667
Provider Name (Legal Business Name): JOEL V LANGEMAAT MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E 17TH ST
BLOOMINGTON IN
47408-1590
US

IV. Provider business mailing address

2162 HARBOR CT
GREENWOOD IN
46143-8392
US

V. Phone/Fax

Practice location:
  • Phone: 812-856-2225
  • Fax:
Mailing address:
  • Phone: 317-979-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001230A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT635
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: