Provider Demographics
NPI:1407966849
Name:LANGER, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:LANGER
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 1:809 CLEARBROOK LN
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-3517
Mailing Address - Country:US
Mailing Address - Phone:651-426-7518
Mailing Address - Fax:
Practice Address - Street 1:100 VILLAGE CENTER DR STE 220
Practice Address - Street 2:
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-3014
Practice Address - Country:US
Practice Address - Phone:651-482-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4606OtherLICENSE#