Individual
MS. LATRIECE HASKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, MFP-C
Contact information
Practice address
5924 VICTORIA PARK WAY, NORTH CHESTERFIELD, VA 23234-5294
(804) 484-9461
Mailing address
5648 DARLINGTON RD, NORTH CHESTERFIELD, VA 23234-4610
(804) 484-9461
Taxonomy
Speciality
Code
Description
License number
State
224Y00000X
Clinical Exercise Physiologist
Primary
88363642
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88363642
MEDICAL FITNESS PRACTITIONER LICENSE NUMBER
VA
Enumeration date
08/16/2022
Last updated
08/16/2022
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