Provider Demographics
NPI:1467406033
Name:LATOURRETTE, DAWN (PT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:LATOURRETTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MILLSTREAM LN
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2917
Mailing Address - Country:US
Mailing Address - Phone:631-751-0618
Mailing Address - Fax:
Practice Address - Street 1:99 HOLLYWOOD DR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3135
Practice Address - Country:US
Practice Address - Phone:631-366-5800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011155225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist