MEDICARE: CAROL LANGER

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4606	OTHER	MN	LICENSE#

General Provider Information

NPI Number	:	1407966849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL LANGER

Provider Business Mailing Address
First Line	:	809 CLEARBROOK LN
Second Line	:
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55127-3517
Country	:	US
Telephone Number	:	651-426-7518
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 VILLAGE CENTER DR STE 220
Second Line	:
City	:	NORTH OAKS
State	:	MN
Zip	:	55127-3014
Country	:	US
Telephone Number	:	651-482-8486
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/21/2009

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Directions to “ CAROL LANGER ” Practice Location

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