Healthcare Provider Details

I. General information

NPI: 1417481102
Provider Name (Legal Business Name): MEGAN LANGERUD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN SWEEN

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 05/04/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 9TH ST E STE 401
WEST FARGO ND
58078-3381
US

IV. Provider business mailing address

9097 E DESERT COVE AVE STE 110
SCOTTSDALE AZ
85260-6276
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-2739
  • Fax: 701-373-0037
Mailing address:
  • Phone: 480-551-4967
  • Fax: 480-860-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2346
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: