Provider Demographics
NPI:1497737084
Name:LANGENBERG, SUZANNE ELIZABETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:LANGENBERG
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 1:4745 SUTTON PARK CT
Mailing Address - Street 2:STE 403
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0255
Mailing Address - Country:US
Mailing Address - Phone:904-371-4649
Mailing Address - Fax:888-393-1099
Practice Address - Street 1:720 ST JOHNS BLUFF RD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225
Practice Address - Country:US
Practice Address - Phone:904-646-1144
Practice Address - Fax:904-928-0039
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY35912Medicare ID - Type Unspecified