Healthcare Provider Details

I. General information

NPI: 1821084955
Provider Name (Legal Business Name): MICHAEL STEPHEN LATSCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 S BRIDGE STREET PLAZA
ELKTON MD
21921-4911
US

IV. Provider business mailing address

1812 MARSH RD STORE 505
WILMINGTON DE
19810-4581
US

V. Phone/Fax

Practice location:
  • Phone: 410-392-0800
  • Fax: 410-392-0815
Mailing address:
  • Phone: 302-793-0432
  • Fax: 302-793-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012062L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22742
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: