Provider Demographics
NPI:1407297161
Name:LEMON, LATANYA BEATRICE (PTA)
Entity Type:Individual
Prefix:MS
First Name:LATANYA
Middle Name:BEATRICE
Last Name:LEMON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:LATANYA
Other - Middle Name:BEATRICE
Other - Last Name:LEMON-CUMPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:814 MAIN ST
Mailing Address - Street 2:APT. 2R
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2611
Mailing Address - Country:US
Mailing Address - Phone:718-926-2486
Mailing Address - Fax:
Practice Address - Street 1:185 SQUIRE RD
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-1234
Practice Address - Country:US
Practice Address - Phone:781-284-0559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8636225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant