Individual
GARY LATCHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
312 E MAIN ST, MARSHALLTOWN, IA 50158-1888
(641) 844-2294
(641) 844-2297
Mailing address
600 OAKMONT LN STE 600C, WESTMONT, IL 60559-5548
(630) 575-6200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
01896
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0475582
—
IA
01
—
39066
WELLMARK
IA
Enumeration date
10/18/2006
Last updated
02/15/2019
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