Provider Demographics
NPI:1790757664
Name:ST.CHARLES, WILLIAM LATHAM (MS, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LATHAM
Last Name:ST.CHARLES
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ETON GREEN CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1633
Mailing Address - Country:US
Mailing Address - Phone:210-698-5235
Mailing Address - Fax:
Practice Address - Street 1:12221 LESLIE RD
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4404
Practice Address - Country:US
Practice Address - Phone:210-397-4859
Practice Address - Fax:210-695-5864
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT0390174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist