Individual
LASTAZIA BACKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3560 US HIGHWAY 301 S, SMITHFIELD, NC 27577-9495
(919) 710-9895
Mailing address
PO BOX 2962, SMITHFIELD, NC 27577-2962
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
17361
NC
Other
Enumeration date
12/07/2020
Last updated
12/07/2020
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