Individual
MARY LOU LANGFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4400 LEAD AVE SE, ALBUQUERQUE, NM 87108-2844
(505) 266-3655
Mailing address
1700 LAFAYETTE DR NE, ALBUQUERQUE, NM 87106-1004
(505) 259-2939
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
212
NM
2251X0800X
Orthopedic Physical Therapist
212
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26785
PRESBYTERIAN HEALTH PLAN
NM
05
—
B5268
—
NM
01
—
NM00Q054
BLUE CROSS BLUE SHIELD
NM
Enumeration date
08/08/2006
Last updated
03/02/2010
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