Individual
LATRELL KENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
433 GRACE AVE, PANAMA CITY, LA 32401
(850) 914-0041
Mailing address
7813 N LAGOON, APT 4G, PANAMA CITY BEACH, FL 32408
(850) 234-3019
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA34156
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BLUE CROSS PROVIDER
C2585
FL
Enumeration date
04/18/2007
Last updated
07/08/2007
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