Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 6745 | SC |
Y | 225200000X | Physical Therapy Assistant | 6745 | SC |
NPI | 1013258771 |
---|---|
Provider Name | Mrs. Carrie B. Latham |
First Address | Blythewood, SC 29016 |
Second Address | Blythewood, SC 29016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2013 |
Last Update Date | 07/06/2018 |