Provider Demographics
NPI:1609942291
Name:LANGSTON, MELISSA (RPT)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:
Last Name:LANGSTON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 CHUCK DAWLEY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4183
Mailing Address - Country:US
Mailing Address - Phone:843-388-0015
Mailing Address - Fax:843-388-0017
Practice Address - Street 1:1106 CHUCK DAWLEY BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4183
Practice Address - Country:US
Practice Address - Phone:843-388-0015
Practice Address - Fax:843-388-0017
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q25896Medicare UPIN