Provider Demographics
NPI: | 1821180126 |
---|---|
Name: | LATUSICK, MICHAEL A (RRT) |
Entity Type: | Individual |
Prefix: | |
First Name: | MICHAEL |
Middle Name: | A |
Last Name: | LATUSICK |
Suffix: | |
Gender: | M |
Credentials: | RRT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 845 RIVERBANKS RD |
Mailing Address - Street 2: | |
Mailing Address - City: | GRANTS PASS |
Mailing Address - State: | OR |
Mailing Address - Zip Code: | 97527-9607 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 541-476-0086 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 500 RAMSEY AVE |
Practice Address - Street 2: | |
Practice Address - City: | GRANTS PASS |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97527-5554 |
Practice Address - Country: | US |
Practice Address - Phone: | 541-472-7000 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-28 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OR | RTP000581 | 2278G1100X, 227900000X, 2279C0205X, 2279E0002X, 2279G0305X, 2279H0200X, 2279P3900X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 2278G1100X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | General Care |
Not Answered | 227900000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | |
Not Answered | 2279C0205X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Critical Care |
Not Answered | 2279E0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Emergency Care |
Not Answered | 2279G0305X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Geriatric Care |
Not Answered | 2279H0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Home Health |
Not Answered | 2279P3900X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Neonatal/Pediatrics |