Provider Demographics
NPI:1740414085
Name:LATANE, RICHARD D (MSPT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
Last Name:LATANE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2315
Mailing Address - Country:US
Mailing Address - Phone:630-963-8006
Mailing Address - Fax:
Practice Address - Street 1:1431 OPUS PL
Practice Address - Street 2:EXECUTIVE TOWERS WEST1 SUITE 310
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1166
Practice Address - Country:US
Practice Address - Phone:866-902-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2015-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist