Provider Demographics
NPI:1750400990
Name:LANGHAM, JILL EILEEN (PT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:EILEEN
Last Name:LANGHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:EILEEN
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
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:405-748-8586
Practice Address - Street 1:3535 NW 58TH ST STE 850
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4806
Practice Address - Country:US
Practice Address - Phone:405-602-3295
Practice Address - Fax:405-602-3297
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist