Provider Demographics
NPI:1013092287
Name:LATIMER, NANCY J (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:J
Last Name:LATIMER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4406 S FLORIDA AVE STE 16
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2182
Mailing Address - Country:US
Mailing Address - Phone:863-648-0099
Mailing Address - Fax:863-709-9740
Practice Address - Street 1:4406 S FLORIDA AVE STE 16
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2182
Practice Address - Country:US
Practice Address - Phone:863-648-0099
Practice Address - Fax:863-709-9740
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT22941OtherPT LIC #