Provider Demographics
NPI:1205382223
Name:LANGHOLFF, CRYSTAL (DPT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:LANGHOLFF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 STEPHENSON HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1118
Mailing Address - Country:US
Mailing Address - Phone:586-510-7997
Mailing Address - Fax:586-439-6240
Practice Address - Street 1:35735 MOUND RD STE 101
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4728
Practice Address - Country:US
Practice Address - Phone:586-510-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist