Provider Demographics
NPI:1750377164
Name:LANGDEN, COLLEEN (PT)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:LANGDEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4737 EL CAMINO AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4938
Mailing Address - Country:US
Mailing Address - Phone:916-487-3473
Mailing Address - Fax:916-487-3483
Practice Address - Street 1:4737 EL CAMINO AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4938
Practice Address - Country:US
Practice Address - Phone:916-487-3473
Practice Address - Fax:916-487-3483
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT112990Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE#
CAZZZ314823Medicare ID - Type UnspecifiedGROUP MEDICARE #