Provider Demographics
NPI:1669468161
Name:LATO, DALLAS AZ (PT)
Entity Type:Individual
Prefix:
First Name:DALLAS
Middle Name:AZ
Last Name:LATO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 E BASELINE RD STE 114
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4626
Mailing Address - Country:US
Mailing Address - Phone:480-396-2781
Mailing Address - Fax:480-854-3094
Practice Address - Street 1:4850 E BASELINE RD
Practice Address - Street 2:SUITE 114
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4625
Practice Address - Country:US
Practice Address - Phone:480-396-2781
Practice Address - Fax:480-854-3094
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ960379Medicaid