Provider Demographics
NPI:1467117218
Name:THOMAS, LATOYA CHAVON
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:CHAVON
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LATOYA
Other - Middle Name:CHAVON
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8650 WATERLYNN CIR NW APT 403
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-0028
Mailing Address - Country:US
Mailing Address - Phone:813-408-4564
Mailing Address - Fax:
Practice Address - Street 1:8650 WATERLYNN CIR NW APT 403
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-0028
Practice Address - Country:US
Practice Address - Phone:813-408-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19860225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist