Healthcare Provider Details

I. General information

NPI: 1861339426
Provider Name (Legal Business Name): JULIE LANGESLAG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 6TH AVE SE
FARIBAULT MN
55021-6343
US

IV. Provider business mailing address

400 6TH AVE SE
FARIBAULT MN
55021-6343
US

V. Phone/Fax

Practice location:
  • Phone: 507-384-6744
  • Fax:
Mailing address:
  • Phone: 507-384-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA586
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: