Provider Demographics
NPI:1013258771
Name:LATHAM, CARRIE B (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:B
Last Name:LATHAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:E
Other - Last Name:BLAKENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:144 LEISURE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4156
Mailing Address - Country:US
Mailing Address - Phone:803-708-2950
Mailing Address - Fax:
Practice Address - Street 1:144 LEISURE LN STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4156
Practice Address - Country:US
Practice Address - Phone:803-708-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6745225100000X, 225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist