Individual
LATASSA DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2 CLAYMONT CT S, PALM COAST, FL 32137-8346
(407) 256-2707
Mailing address
PO BOX 350068, PALM COAST, FL 32135-0068
(407) 256-2707
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA25971
FL
225700000X
Massage Therapist
MT007924
GA
Other
Enumeration date
08/19/2020
Last updated
08/19/2020
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