Individual
LISA GORDON LATOURETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
8575 RIXLEW LN, MANASSAS, VA 20109-3701
(703) 257-3364
Mailing address
8575 RIXLEW LN, MANASSAS, VA 20109-3701
(703) 257-3364
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305203147
VA
Other
Enumeration date
05/11/2006
Last updated
12/30/2011
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