Individual
LATASHA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
1912 CENTRAL DR STE J, BEDFORD, TX 76021-5894
(817) 692-2869
Mailing address
1848 WESTERN CENTER BLVD APT 628, FORT WORTH, TX 76131-2263
(817) 692-2869
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT123216
TX
225700000X
Massage Therapist
MY123216
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720629033
—
TX
Enumeration date
10/08/2019
Last updated
08/06/2020
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