MEDICARE: MS. JOAN LANGFELD P.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
1	225100000X	Physical Therapist	23058	CA

General Provider Information

NPI Number	:	1568664357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOAN LANGFELD P.T.

Provider Business Mailing Address
First Line	:	5225 VINE HILL RD # A
Second Line	:
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-2022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 TESCONI CIR STE H
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4611
Country	:	US
Telephone Number	:	707-568-0123
Fax Number	:

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

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	07/08/2007

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