Individual
LACHETTA BROADWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
520 58TH ST STE 106, KENOSHA, WI 53140-4114
(262) 551-1317
Mailing address
2401 2ND ST, KENOSHA, WI 53140-1052
(262) 551-1317
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
12380-146
WI
Other
Enumeration date
04/22/2024
Last updated
04/22/2024
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