Provider Demographics
NPI:1235730086
Name:LANGLEY, MEREDITH GAVIN (PT)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:GAVIN
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CLOVER LEAF DR
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-8056
Mailing Address - Country:US
Mailing Address - Phone:501-303-8439
Mailing Address - Fax:
Practice Address - Street 1:3231 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-9201
Practice Address - Country:US
Practice Address - Phone:501-847-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist