Provider Demographics
NPI:1780795971
Name:TATLOW, CARMEN CATHERINE (PT DPT)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:CATHERINE
Last Name:TATLOW
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CARLSBAD LN
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-6070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24582 DEL PRADO
Practice Address - Street 2:STE C
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3843
Practice Address - Country:US
Practice Address - Phone:949-443-0713
Practice Address - Fax:949-443-0721
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT32991OtherPT STATE LICENSE