Healthcare Provider Details

I. General information

NPI: 1457325458
Provider Name (Legal Business Name): ANNABELLA S LATOTZKE DPT, ATC, LAT, MTC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S ORLANDO AVE
WINTER PARK FL
32789-4867
US

IV. Provider business mailing address

1285 ORANGE AVE
WINTER PARK FL
32789-4984
US

V. Phone/Fax

Practice location:
  • Phone: 407-691-7697
  • Fax:
Mailing address:
  • Phone: 407-647-2287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19661
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL1906
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT19661
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: