Provider Demographics
NPI:1326662545
Name:JONES, CHANDA LATOYA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:CHANDA
Middle Name:LATOYA
Last Name:JONES
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 CLANTON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1212
Mailing Address - Country:US
Mailing Address - Phone:704-241-9440
Mailing Address - Fax:
Practice Address - Street 1:6725 FAIRVIEW RD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-5327
Practice Address - Country:US
Practice Address - Phone:704-241-9440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8708225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty