Provider Demographics
NPI:1114565967
Name:LANGLOIS, MINDY (MA, ATC, CSCS, ITAT)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:LANGLOIS
Suffix:
Gender:F
Credentials:MA, ATC, CSCS, ITAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29401 SW 125TH AVE BUILDING 600
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33039-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29401 SW 125TH AVE BUILDING 741
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33039-1615
Practice Address - Country:US
Practice Address - Phone:616-638-1357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0031182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer