Provider Demographics
NPI:1932167665
Name:LATIMER, NOALL H (PT)
Entity Type:Individual
Prefix:
First Name:NOALL
Middle Name:H
Last Name:LATIMER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 S 8400 W
Mailing Address - Street 2:SUITE F
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-1884
Mailing Address - Country:US
Mailing Address - Phone:801-250-9107
Mailing Address - Fax:801-250-7840
Practice Address - Street 1:3441 S 8400 W
Practice Address - Street 2:SUITE F
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-1884
Practice Address - Country:US
Practice Address - Phone:801-250-9107
Practice Address - Fax:801-250-7840
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1133172401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist