Provider Demographics
NPI:1659799898
Name:LATZ, ROBERT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:LATZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8459 US HIGHWAY 42 # 297F
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-8350
Mailing Address - Country:US
Mailing Address - Phone:859-802-7274
Mailing Address - Fax:
Practice Address - Street 1:8459 US HIGHWAY 42 # 297F
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-8350
Practice Address - Country:US
Practice Address - Phone:859-802-7274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist