Organization
EAGLE PHYSICAL THERAPY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL K LANGLEY MPT, OCS (OWNER)
(208) 939-3332
Entity
Organization
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, SUITE 100, EAGLE, ID 83616-6568
(208) 939-3332
(208) 939-3338
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010026792
BLUE SHIELD
—
01
—
332828
PRIVATE HEALTHCARE SYSTEM
—
05
—
806054600
—
ID
01
—
DB2265
RAILROAD MEDICARE
—
01
—
T9420
BLUE CROSS
—
Enumeration date
10/06/2006
Last updated
09/01/2009
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