Healthcare Provider Details

I. General information

NPI: 1780428466
Provider Name (Legal Business Name): JACOB LATKOFSKY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 TARBORO ST SW
WILSON NC
27893-3437
US

IV. Provider business mailing address

7387 WOODCROFT DR
ANDERSON TOWNSHIP OH
45230-4310
US

V. Phone/Fax

Practice location:
  • Phone: 252-399-8040
  • Fax:
Mailing address:
  • Phone: 567-277-8306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT021215
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304465
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP058414T
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: