Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A-0889 | NM |
NPI | 1013343219 |
---|---|
Provider Name | Charlotte Latham |
First Address | Albuquerque, NM 87187-6843 |
Second Address | Los Ranchos, NM 87114-1200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2013 |
Last Update Date | 19/09/2013 |