MEDICARE: LORI LANGAN PTA, LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	NA	MT

General Provider Information

NPI Number	:	1033244314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI LANGAN PTA, LMT

Provider Business Mailing Address
First Line	:	5655 KRISTIN LN
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-2953
Country	:	US
Telephone Number	:	406-251-7117
Fax Number	:

Provider Business Practice Location Address
First Line	:	2419 MULLAN RD
Second Line	:	SUITE A
City	:	MISSOULA
State	:	MT
Zip	:	59808-1827
Country	:	US
Telephone Number	:	406-543-1955
Fax Number	:	406-543-1506

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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