Provider Demographics
NPI:1316957145
Name:LANGFORD, JASON S (MPT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:S
Last Name:LANGFORD
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:816-226-4011
Mailing Address - Fax:816-524-6115
Practice Address - Street 1:1004 PROGRESS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-6326
Practice Address - Country:US
Practice Address - Phone:913-351-3838
Practice Address - Fax:913-351-3939
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1103375225100000X
MO2014023790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4370086OtherMEDICARE PTAN
37252038OtherBCBS KC
KSKA2868037OtherMEDICARE PTAN
KSUSES NPIOtherBCBS-KANSAS