Provider Demographics
NPI:1275042525
Name:LANGFORD, MICHELLE KRISTIN
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KRISTIN
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 CORDOVA LOOP
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-0114
Mailing Address - Country:US
Mailing Address - Phone:210-418-0600
Mailing Address - Fax:
Practice Address - Street 1:1900 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7520
Practice Address - Country:US
Practice Address - Phone:512-396-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2106515225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant