Provider Demographics
NPI:1902904055
Name:LATHAM, DARLENE ASHLEY (RPTA)
Entity Type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:ASHLEY
Last Name:LATHAM
Suffix:
Gender:F
Credentials:RPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:IVA
Mailing Address - State:SC
Mailing Address - Zip Code:29655-9177
Mailing Address - Country:US
Mailing Address - Phone:864-348-3630
Mailing Address - Fax:
Practice Address - Street 1:1501 E GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2004
Practice Address - Country:US
Practice Address - Phone:864-226-8356
Practice Address - Fax:864-261-6480
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC741225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant