Provider Demographics
NPI:1447761556
Name:LANGSDORF, KALLI (ATC)
Entity Type:Individual
Prefix:
First Name:KALLI
Middle Name:
Last Name:LANGSDORF
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KALLI
Other - Middle Name:MICHELLE
Other - Last Name:ICKES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC
Mailing Address - Street 1:2 MEADOWBROOK
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 MEADOWBROOK
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4726
Practice Address - Country:US
Practice Address - Phone:714-349-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer