MEDICARE: MR. EDWARD LANGEHENNIG MSPT

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	225100000X	Physical Therapist	1698	NV

General Provider Information

NPI Number	:	1285927293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD LANGEHENNIG MSPT

Provider Business Mailing Address
First Line	:	6020 TRAVIATA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-0477
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2075 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5188
Country	:	US
Telephone Number	:	702-364-7746
Fax Number	:

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

Provider Enumeration Date	:	05/24/2011
Last Update Date	:	05/24/2011

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