Healthcare Provider Details

I. General information

NPI: 1699801381
Provider Name (Legal Business Name): LANGFORD CONSULTING, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 MOUNTAIN RD
GRANTS NM
87020-2602
US

IV. Provider business mailing address

242 MOUNTAIN RD
GRANTS NM
87020-2602
US

V. Phone/Fax

Practice location:
  • Phone: 505-876-6030
  • Fax: 505-876-6151
Mailing address:
  • Phone: 505-876-6030
  • Fax: 505-876-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number212
License Number StateNM

VIII. Authorized Official

Name: MARY LOU LANGFORD
Title or Position: PRESIDENT
Credential: PT, BHS
Phone: 505-876-6030