Individual
MR. RANDALL KEITH LANGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT, OCS
Contact information
Practice address
457 S FITNESS PL, SUITE 100, EAGLE, ID 83616-6568
(208) 939-3332
(208) 939-3338
Mailing address
457 S FITNESS PL, EAGLE, ID 83616-6568
(208) 939-3332
(208) 939-3338
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RPT 655
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010009145
BLUE SHIELD
—
05
—
002779700
—
ID
01
—
650012139
RAILROAD MEDICARE
—
01
—
T4371
BLUE CROSS
—
Enumeration date
10/06/2006
Last updated
07/23/2008
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