Provider Demographics
NPI:1467934950
Name:CHILDS, LATEZIA MONET (PTA)
Entity Type:Individual
Prefix:
First Name:LATEZIA
Middle Name:MONET
Last Name:CHILDS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-2201
Mailing Address - Country:US
Mailing Address - Phone:972-394-7141
Mailing Address - Fax:
Practice Address - Street 1:1855 CHEYENNE DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-2201
Practice Address - Country:US
Practice Address - Phone:972-394-7141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2125620225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant