Provider Demographics
NPI:1114991403
Name:LATOURELLE, JAMES GARY (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GARY
Last Name:LATOURELLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 FOX HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02633-1410
Mailing Address - Country:US
Mailing Address - Phone:508-945-3005
Mailing Address - Fax:
Practice Address - Street 1:225 CRANBERRY HWY
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-3255
Practice Address - Country:US
Practice Address - Phone:508-255-4181
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist