Provider Demographics
NPI:1235517038
Name:ESMAILI JAVADI LANGEROUDI, NAZANIN (PT)
Entity Type:Individual
Prefix:MS
First Name:NAZANIN
Middle Name:
Last Name:ESMAILI JAVADI LANGEROUDI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:NAZANIN
Other - Middle Name:
Other - Last Name:E. J. LANGEROUDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8950 UNIVERSITY BLVD STE 200A
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9889
Practice Address - Country:US
Practice Address - Phone:843-414-1140
Practice Address - Fax:843-553-2946
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist