Provider Demographics
NPI:1679818249
Name:LATONA, KELLY TERESA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:TERESA
Last Name:LATONA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:TERESA
Other - Last Name:KRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:60 CASTLE SHANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:MT LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:15228-2202
Mailing Address - Country:US
Mailing Address - Phone:412-344-4241
Mailing Address - Fax:
Practice Address - Street 1:200 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1028
Practice Address - Country:US
Practice Address - Phone:412-489-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013928L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist