=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992920003
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA J LANGLOIS PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2007
-----------------------------------------------------
Last Update Date | 08/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 TAUNTON GRN STE 206
-----------------------------------------------------
City | TAUNTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02780-3253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-823-2225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 415 NEPONSET AVE
-----------------------------------------------------
City | DORCHESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02122-3168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-218-5585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 9524
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------