Provider Demographics
NPI:1023776762
Name:LATCH, THERESA (DPT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:LATCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 PARK AVE APT 419
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2758
Mailing Address - Country:US
Mailing Address - Phone:402-983-0085
Mailing Address - Fax:
Practice Address - Street 1:104 S 17TH STREET
Practice Address - Street 2:
Practice Address - City:SCHUYLER
Practice Address - State:NE
Practice Address - Zip Code:68661
Practice Address - Country:US
Practice Address - Phone:402-352-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist