Provider Demographics
NPI:1184494965
Name:LATZO, LISA MICHELLE (DPT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MICHELLE
Last Name:LATZO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:PACHECO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:580 WHITE PLAINS RD STE 120A
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5106
Mailing Address - Country:US
Mailing Address - Phone:914-603-8600
Mailing Address - Fax:914-603-8601
Practice Address - Street 1:580 WHITE PLAINS RD STE 120A
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5106
Practice Address - Country:US
Practice Address - Phone:914-603-8600
Practice Address - Fax:914-603-8601
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021796-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist