Provider Demographics
NPI:1760894141
Name:LANGHELD, MATTHEW (PTA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LANGHELD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 COLUMBIA ROAD 78
Mailing Address - Street 2:
Mailing Address - City:WALDO
Mailing Address - State:AR
Mailing Address - Zip Code:71770-8983
Mailing Address - Country:US
Mailing Address - Phone:870-299-2989
Mailing Address - Fax:
Practice Address - Street 1:168 COLUMBIA ROAD 78
Practice Address - Street 2:
Practice Address - City:WALDO
Practice Address - State:AR
Practice Address - Zip Code:71770-8983
Practice Address - Country:US
Practice Address - Phone:870-299-2989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3816225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant