Provider Demographics
NPI:1104957406
Name:LANGER, CARRIE L (MPT, ATR, PRC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:LANGER
Suffix:
Gender:F
Credentials:MPT, ATR, PRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:ROBERTS
Mailing Address - State:WI
Mailing Address - Zip Code:54023-9617
Mailing Address - Country:US
Mailing Address - Phone:651-730-7771
Mailing Address - Fax:651-730-7772
Practice Address - Street 1:731 BIELENBERG DR
Practice Address - Street 2:SUITE 107
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1700
Practice Address - Country:US
Practice Address - Phone:651-730-7771
Practice Address - Fax:651-730-7772
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN447602600Medicaid
MN650001369Medicare ID - Type Unspecified