Provider Demographics
NPI:1962494104
Name:LANGFORD, TANDRA LOVE (PT)
Entity Type:Individual
Prefix:MRS
First Name:TANDRA
Middle Name:LOVE
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:TANDRA
Other - Middle Name:LOVE
Other - Last Name:BRILLHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5950 BRYANT IRVIN RD
Mailing Address - Street 2:#100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4210
Mailing Address - Country:US
Mailing Address - Phone:817-294-4646
Mailing Address - Fax:817-294-4649
Practice Address - Street 1:5950 BRYANT IRVIN RD
Practice Address - Street 2:#100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4210
Practice Address - Country:US
Practice Address - Phone:817-294-4646
Practice Address - Fax:817-294-4649
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1136232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX062865301Medicaid
TX8T0363OtherBCBS
TX8T0363OtherBCBS
TX062865301Medicaid