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NPI Code Detail

MEDICARE: MICHELLE LANGLEY L.M.T.

MEDICARE: MICHELLE LANGLEY L.M.T.
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
1225700000XMassage TherapistMT108158TX

General Provider Information

NPI Number : 1417190794
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE LANGLEY L.M.T.
Provider Business Mailing Address
First Line : 4634 CAMP BOWIE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-3744
Country : US
Telephone Number : 817-735-3839
Fax Number : 817-735-3837
Provider Business Practice Location Address
First Line : 4634 CAMP BOWIE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-3744
Country : US
Telephone Number : 817-735-3839
Fax Number : 817-735-3837
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2009
Last Update Date : 04/15/2009

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Directions to “ MICHELLE LANGLEY L.M.T.” Practice Location

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