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General NPI Number Information
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NPI Number | 1487664132
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Entity Type | Individual
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Provider Name | MARY LOU LANGFORD PT
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 03/02/2010
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Provider Practice Location Address
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Address Line | 4400 LEAD AVE SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-2844
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Country | US
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Telephone | 505-266-3655
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 LAFAYETTE DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-1004
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Country | US
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Telephone | 505-259-2939
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 212
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 212
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License Number State | NM
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