Provider Demographics
NPI:1730724428
Name:WINGFIELD-HOWARD, LATISHA
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:
Last Name:WINGFIELD-HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 BONAIRE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811-7814
Mailing Address - Country:US
Mailing Address - Phone:870-245-7070
Mailing Address - Fax:
Practice Address - Street 1:4010 CHRIS DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-4189
Practice Address - Country:US
Practice Address - Phone:870-245-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-17
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1401225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant