MEDICARE: MRS. JEANINE LANGENBACH PT

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	174400000X	Specialist	1829	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	007171346	OTHER	AZ	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	AZ0460200	OTHER	AZ	BCBS

General Provider Information

NPI Number	:	1174516868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANINE LANGENBACH PT

Provider Business Mailing Address
First Line	:	726 W. AIRE LIBRE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-7910
Country	:	US
Telephone Number	:	602-938-9839
Fax Number	:	602-938-9839

Provider Business Practice Location Address
First Line	:	726 W. AIRE LIBRE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-7910
Country	:	US
Telephone Number	:	602-938-9839
Fax Number	:	602-938-9839

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	11/06/2008

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