Healthcare Provider Details

I. General information

NPI: 1447683149
Provider Name (Legal Business Name): KRISTEN LATTIMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 JONES WYND
WAKE FOREST NC
27587-7380
US

IV. Provider business mailing address

1327 SE TACOMA ST UNIT 122
PORTLAND OR
97202-6639
US

V. Phone/Fax

Practice location:
  • Phone: 202-681-1474
  • Fax: 888-645-6068
Mailing address:
  • Phone: 202-681-1474
  • Fax: 888-645-6068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14409
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: