Provider Demographics
NPI:1184227720
Name:HARRIS, LATANYA MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:LATANYA
Middle Name:MICHELLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ROYAL
Other - Middle Name:TOUCH
Other - Last Name:MASSAGE THERAPY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ROYALTOUCH MASSAGE T
Mailing Address - Street 1:2934 W 25TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4176
Mailing Address - Country:US
Mailing Address - Phone:312-799-0146
Mailing Address - Fax:
Practice Address - Street 1:2934 W 25TH ST APT A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4176
Practice Address - Country:US
Practice Address - Phone:312-799-0146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.016092225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist