Healthcare Provider Details

I. General information

NPI: 1770096968
Provider Name (Legal Business Name): ADRIAN JOHN LATSCU PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 W NEWBERRY RD
GAINESVILLE FL
32607-2249
US

IV. Provider business mailing address

4126 NW 44TH DR
GAINESVILLE FL
32606-4593
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-2116
  • Fax:
Mailing address:
  • Phone: 352-213-8422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA26151
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: