Provider Demographics
NPI:1023130572
Name:LANGHAM, RONALD LEROY JR (PT)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:LEROY
Last Name:LANGHAM
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 NW 140TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1973
Mailing Address - Country:US
Mailing Address - Phone:405-748-8586
Mailing Address - Fax:
Practice Address - Street 1:3535 NW 58TH ST
Practice Address - Street 2:SUITE 850
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4802
Practice Address - Country:US
Practice Address - Phone:405-602-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2918OtherPHYSICAL THERAPY LICENSE