Healthcare Provider Details

I. General information

NPI: 1396482147
Provider Name (Legal Business Name): RYAN LANGER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 HIGHWAY 96 E STE 120
VADNAIS HEIGHTS MN
55127-2557
US

IV. Provider business mailing address

480 HIGHWAY 96 E STE 120
VADNAIS HEIGHTS MN
55127-2557
US

V. Phone/Fax

Practice location:
  • Phone: 651-482-8486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12594
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: