MEDICARE: JENNIFER K LANGLEY ATC

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	2255A2300X	Athletic Trainer	RT003621	PA

General Provider Information

NPI Number	:	1831336668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER K LANGLEY ATC

Provider Business Mailing Address
First Line	:	4410 TOWNSHIP LINE RD
Second Line	:	APARTMENT K3B
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-4137
Country	:	US
Telephone Number	:	484-431-6431
Fax Number	:

Provider Business Practice Location Address
First Line	:	4410 TOWNSHIP LINE RD
Second Line	:	APARTMENT K3B
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-4137
Country	:	US
Telephone Number	:	484-431-6431
Fax Number	:

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

Provider Enumeration Date	:	01/15/2009
Last Update Date	:	01/15/2009

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