Provider Demographics
NPI:1790983856
Name:LATHROP, JAMES A (C-PED)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:LATHROP
Suffix:
Gender:M
Credentials:C-PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 CHARLESTON AVE
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4202
Mailing Address - Country:US
Mailing Address - Phone:217-234-3811
Mailing Address - Fax:
Practice Address - Street 1:821 CHARLESTON AVE
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4202
Practice Address - Country:US
Practice Address - Phone:217-234-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier