Provider Demographics
NPI:1427217108
Name:LATHAM, DENISE A (LMP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:LATHAM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:A
Other - Last Name:RADOC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32717 1ST AVE S STE 9
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5758
Mailing Address - Country:US
Mailing Address - Phone:253-874-6620
Mailing Address - Fax:253-874-2542
Practice Address - Street 1:32717 1ST AVE S STE 9
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5758
Practice Address - Country:US
Practice Address - Phone:253-874-6620
Practice Address - Fax:253-874-2542
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60012033225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist