Individual
MS. LATARA S JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4389 BEAUFORT RD, HAVELOCK, NC 28532
(252) 466-0344
Mailing address
1512 MESQUITE CT, HAVELOCK, NC 28532-8503
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A5956
NC
Other
Enumeration date
11/04/2024
Last updated
11/04/2024
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