MEDICARE: MR. JAMES GARY LATOURELLE P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4190	MA

General Provider Information

NPI Number	:	1114991403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES GARY LATOURELLE P.T.

Provider Business Mailing Address
First Line	:	70 FOX HILL RD
Second Line	:
City	:	CHATHAM
State	:	MA
Zip	:	02633-1410
Country	:	US
Telephone Number	:	508-945-3005
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 CRANBERRY HWY
Second Line	:
City	:	ORLEANS
State	:	MA
Zip	:	02653-3255
Country	:	US
Telephone Number	:	508-255-4181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. JAMES GARY LATOURELLE P.T.” Practice Location

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