Provider Demographics
NPI:1861059974
Name:LANGFORD, TANYA F
Entity type:Individual
Prefix:MISS
First Name:TANYA
Middle Name:F
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 CEDAR AVE SO.
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407
Mailing Address - Country:US
Mailing Address - Phone:612-728-0223
Mailing Address - Fax:
Practice Address - Street 1:3627 CEDAR AVE NO.
Practice Address - Street 2:1166 S ROBERT ST. ST. PAUL WEST
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118
Practice Address - Country:US
Practice Address - Phone:651-209-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist