Individual provider Active NPI

Carolyn Latham, DPT

  • Physical Therapist
  • San Rafael, CA
National Provider Identifier
1205246071
Registry record updated Jul 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT298393 Issued in CA
Practice address
7 Meriam Dr
San Rafael, CA 94903-2826
Phone
(615) 604-5367
Fax
(415) 492-1925
NPI assigned
May 2, 2014
Last updated
Jul 8, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 036762 NY
Physical Therapist 225100000X PT298393 CA Primary
Orthopedic Physical Therapist 2251X0800X 0016119 CO

Addresses

Primary practice location

7 Meriam Dr
San Rafael, CA 94903-2826

Mailing address

14 Kientz LN
San Anselmo, CA 94960-2163
Phone (615) 604-5367

Other practice location 1

14 Kientz Ln
San Anselmo, CA 94960-2163
Phone (615) 604-5367

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
036762NYMDDentist
PT298393CAMDPhysical Therapist
0016119COMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Verity Physical Therapy & Wellness CurrentSince Aug 1, 2019 Accepting new patients

Locations

2300 Canyon Blvd
Ste 5
Boulder, CO 80302
Phone (303) 880-8296

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751932800000",
    "number": "1205246071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 KIENTZ LN",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949602163",
            "telephone_number": "615-604-5367",
            "fax_number": "415-492-1925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 MERIAM DR",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032826",
            "telephone_number": "615-604-5367",
            "fax_number": "415-492-1925"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14 Kientz Ln",
            "address_purpose": "LOCATION",
            "city": "San Anselmo",
            "state": "CA",
            "postal_code": "949602163",
            "country_code": "US",
            "telephone_number": "615-604-5367",
            "fax_number": "415-492-1925",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LATHAM",
        "first_name": "CAROLYN",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-02",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "036762",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT298393",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CO",
            "license": "0016119",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.