Provider Demographics
NPI:1972700979
Name:LANGRILL, COLLEEN LISA (PT)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:LISA
Last Name:LANGRILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:C
Other - Middle Name:LISA
Other - Last Name:LANGRILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1050 S NORTHPOINT ROAD
Mailing Address - Street 2:SUITE 204-205
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3336
Mailing Address - Country:US
Mailing Address - Phone:410-285-0740
Mailing Address - Fax:410-282-5861
Practice Address - Street 1:1050 S NORTHPOINT ROAD
Practice Address - Street 2:SUITE 204-205
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3336
Practice Address - Country:US
Practice Address - Phone:410-285-0740
Practice Address - Fax:410-282-5861
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ433Medicare ID - Type Unspecified