Provider Demographics
NPI:1114791456
Name:BAILEY, LATIVIA ARMISS
Entity Type:Individual
Prefix:
First Name:LATIVIA
Middle Name:ARMISS
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 BUSINESS CENTER DR APT 716
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2487
Mailing Address - Country:US
Mailing Address - Phone:713-899-5358
Mailing Address - Fax:
Practice Address - Street 1:2400 BUSINESS CENTER DR APT 716
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2487
Practice Address - Country:US
Practice Address - Phone:713-899-5358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT127418225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist