Basic Information
| Provider Information | |||||||||
| NPI: | 1447344056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANGDON | ||||||||
| FirstName: | ELLARIE | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 SW 10TH AVE | ||||||||
| Address2: | MEDICAL STAFF SERVICES | ||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666041301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853546241 | ||||||||
| FaxNumber: | 7852704343 | ||||||||
| Practice Location | |||||||||
| Address1: | 2660 SW 3RD ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666062442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853546116 | ||||||||
| FaxNumber: | 7853545166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 01/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | KS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | 11-02113 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 646300 | 01 | KS | FIRST GUARD GROUP NUMBER | OTHER | 140907 | 01 | KS | BLUE CROSS BLUE SHIELD | OTHER | 200330470A | 05 | KS | MEDICAID |