Provider Demographics
NPI:1679740179
Name:LATHAN, NORMA MORRIS (PT)
Entity type:Individual
Prefix:MRS
First Name:NORMA
Middle Name:MORRIS
Last Name:LATHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 W RIO ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-1040
Mailing Address - Country:US
Mailing Address - Phone:414-353-6636
Mailing Address - Fax:414-353-6636
Practice Address - Street 1:11901 W RIO ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-1040
Practice Address - Country:US
Practice Address - Phone:414-353-6636
Practice Address - Fax:414-353-6636
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist