Provider Demographics
NPI:1568740629
Name:LANGAN, KELLY MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:LANGAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:GHIOTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:93 SPRINGVIEW LN UNIT B
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8143
Mailing Address - Country:US
Mailing Address - Phone:843-797-5050
Mailing Address - Fax:843-797-3633
Practice Address - Street 1:93 SPRINGVIEW LN UNIT B
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8143
Practice Address - Country:US
Practice Address - Phone:843-797-5050
Practice Address - Fax:843-797-3633
Is Sole Proprietor?:No
Enumeration Date:2011-07-23
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014288225100000X
IN05010623A225100000X
TN10402225100000X
SC10280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH4302Medicaid