Healthcare Provider Details

I. General information

NPI: 1528276839
Provider Name (Legal Business Name): SUSAN A. LANGFORD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-7613
US

IV. Provider business mailing address

PO BOX 56873
ALBUQUERQUE NM
87187-6873
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-2670
  • Fax:
Mailing address:
  • Phone: 505-341-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA72
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: