Provider Demographics
NPI:1043539497
Name:LANGFORD, JAY M (DPT)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:M
Last Name:LANGFORD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 E 1000 N
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1850
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26 E 1000 N
Practice Address - Street 2:SUITE B
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1850
Practice Address - Country:US
Practice Address - Phone:435-896-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7600253-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist