Provider Demographics
NPI:1831115609
Name:LANGERWERF, LEIGH KEITH (DPT)
Entity Type:Individual
Prefix:MR
First Name:LEIGH
Middle Name:KEITH
Last Name:LANGERWERF
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1314
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-1314
Mailing Address - Country:US
Mailing Address - Phone:530-891-8220
Mailing Address - Fax:530-891-8226
Practice Address - Street 1:125 RALEY BOULEVARD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928
Practice Address - Country:US
Practice Address - Phone:530-891-8220
Practice Address - Fax:530-891-8226
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29876225100000X
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT288762OtherPTAN