Provider Demographics
NPI:1417373804
Name:LOVELESS-KNOX, LATOYA (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:LOVELESS-KNOX
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 PALO ALTO ST
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-1210
Mailing Address - Country:US
Mailing Address - Phone:850-736-7061
Mailing Address - Fax:
Practice Address - Street 1:2161 PALO ALTO ST
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-1210
Practice Address - Country:US
Practice Address - Phone:850-736-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management