Provider Demographics
NPI:1710778964
Name:MIMMS, LANGHSTON (DPT, MBA)
Entity type:Individual
Prefix:
First Name:LANGHSTON
Middle Name:
Last Name:MIMMS
Suffix:
Gender:M
Credentials:DPT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 QUEBEC DR
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62203-2217
Mailing Address - Country:US
Mailing Address - Phone:925-640-0765
Mailing Address - Fax:
Practice Address - Street 1:5675 ROE BLVD STE 240
Practice Address - Street 2:
Practice Address - City:ROELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66205-2515
Practice Address - Country:US
Practice Address - Phone:913-632-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist