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NPI Code Detail

MEDICARE: JACOB LATKOFSKY PT, DPT

MEDICARE: JACOB LATKOFSKY PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT021215OH
2225100000XPhysical Therapist5501304465MI
3225100000XPhysical TherapistCP058414TNC

General Provider Information

NPI Number : 1780428466
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB LATKOFSKY PT, DPT
Provider Business Mailing Address
First Line : 7387 WOODCROFT DR
Second Line :
City : ANDERSON TOWNSHIP
State : OH
Zip : 45230-4310
Country : US
Telephone Number : 567-277-8306
Fax Number :
Provider Business Practice Location Address
First Line : 1705 TARBORO ST SW
Second Line :
City : WILSON
State : NC
Zip : 27893-3437
Country : US
Telephone Number : 252-399-8040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2024
Last Update Date : 06/10/2026

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