| Doctor Name: | DR. LATASHA RENEE' BLANTON |
| NPI Number: | 1518151091 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.P.T. |
| License Number: | 2305204166 |
| Business Practice Address: | 2777 Jefferson Davis Hwy Suite109 Stafford, VA - 225546219 |
| Business Phone Number: | 5403188615 |
| Business Fax Number: | 5403188619 |
| Mailing Address: | 2777 Jefferson Davis Hwy Ste 109, STAFFORD |
| State: | VA |
| Postal Code: | 225548323 |
| Phone Number: | 5403188615 |
| Fax Number: | 5403188619 |
| NPI Enumeration Date: | 08/28/2007 |
| NPI Last Update Date: | 09/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 2305204166 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |