Provider Demographics
NPI:1174516868
Name:LANGENBACH, JEANINE (PT)
Entity type:Individual
Prefix:MRS
First Name:JEANINE
Middle Name:
Last Name:LANGENBACH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 W. AIRE LIBRE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-7910
Mailing Address - Country:US
Mailing Address - Phone:602-938-9839
Mailing Address - Fax:602-938-9839
Practice Address - Street 1:726 W. AIRE LIBRE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-7910
Practice Address - Country:US
Practice Address - Phone:602-938-9839
Practice Address - Fax:602-938-9839
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1829174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ007171346OtherAETNA
AZ348509Medicaid
AZAZ0460200OtherBCBS