Provider Demographics
NPI:1669019840
Name:ASIATICO, LANGSTON MICHAEL (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:LANGSTON
Middle Name:MICHAEL
Last Name:ASIATICO
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E BRANNON RD UNIT 227
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-6094
Mailing Address - Country:US
Mailing Address - Phone:270-300-4926
Mailing Address - Fax:
Practice Address - Street 1:801 E BRANNON RD UNIT 227
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-6094
Practice Address - Country:US
Practice Address - Phone:270-300-4926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 390200000X
KY2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program