Provider Demographics
NPI:1366886970
Name:PLUMMER, LATOYA CARSON (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:CARSON
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17223 COVENTRY ESTATES BLVD
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-3317
Mailing Address - Country:US
Mailing Address - Phone:228-596-1630
Mailing Address - Fax:
Practice Address - Street 1:3179 MALLETT RD STE D
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-9302
Practice Address - Country:US
Practice Address - Phone:228-392-4710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT5030225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist