Provider Demographics
NPI:1639317704
Name:MISTER, LATONYA P (DPT)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:P
Last Name:MISTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 AIRLINE DR STE 300-288
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2946
Mailing Address - Country:US
Mailing Address - Phone:601-405-4758
Mailing Address - Fax:
Practice Address - Street 1:1743 SWAN LAKE RD STE E
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5366
Practice Address - Country:US
Practice Address - Phone:318-553-5022
Practice Address - Fax:318-594-3088
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
OK4653225100000X
GAPT009525225100000X
LA10520R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist