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NPI Code Detail

MEDICARE: AMANDA LANGWELL

MEDICARE:   AMANDA  LANGWELL
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
1225200000XPhysical Therapy Assistant

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11433OTHEROKLICENSE #

General Provider Information

NPI Number : 1376653097
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA LANGWELL
Provider Business Mailing Address
First Line : 1214 E CORONA ST
Second Line :
City : ADA
State : OK
Zip : 74820-2631
Country : US
Telephone Number : 580-399-5015
Fax Number :
Provider Business Practice Location Address
First Line : 2020 ARLINGTON ST STE 1
Second Line :
City : ADA
State : OK
Zip : 74820-2822
Country : US
Telephone Number : 580-332-5124
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 07/08/2007

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Directions to “ AMANDA LANGWELL ” Practice Location

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