Provider Demographics
NPI:1831336668
Name:LANGLEY, JENNIFER K (ATC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 TOWNSHIP LINE RD
Mailing Address - Street 2:APARTMENT K3B
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-4137
Mailing Address - Country:US
Mailing Address - Phone:484-431-6431
Mailing Address - Fax:
Practice Address - Street 1:4410 TOWNSHIP LINE RD
Practice Address - Street 2:APARTMENT K3B
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4137
Practice Address - Country:US
Practice Address - Phone:484-431-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0036212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer