Individual
DALLAS AZ LATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4850 E BASELINE RD, SUITE 114, MESA, AZ 85206-4625
(480) 396-2781
(480) 854-3094
Mailing address
4850 E BASELINE RD STE 114, MESA, AZ 85206-4626
(480) 396-2781
(480) 854-3094
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3551
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
960379
—
AZ
Enumeration date
09/21/2005
Last updated
11/10/2023
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