Provider Demographics
NPI:1275310625
Name:LATHAN, CHERISE (PT, DPT, NCS)
Entity Type:Individual
Prefix:
First Name:CHERISE
Middle Name:
Last Name:LATHAN
Suffix:
Gender:F
Credentials:PT, DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 TRINIDAD AVE NE APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7849
Mailing Address - Country:US
Mailing Address - Phone:949-275-4822
Mailing Address - Fax:
Practice Address - Street 1:1705 TRINIDAD AVE NE APT 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7849
Practice Address - Country:US
Practice Address - Phone:949-275-4822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT8722022251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology