Provider Demographics
NPI:1598396210
Name:HILLS, LATEEFAH (LMT)
Entity Type:Individual
Prefix:
First Name:LATEEFAH
Middle Name:
Last Name:HILLS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10033 E POMONA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-1369
Mailing Address - Country:US
Mailing Address - Phone:225-454-0950
Mailing Address - Fax:
Practice Address - Street 1:8674 QUARTERS LAKE RD # 7
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2172
Practice Address - Country:US
Practice Address - Phone:225-454-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA-5181173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
224102OtherAMERICAN MASSAGE THERAPY ASSOCIATION
LALA-5181OtherLOUISIANA BOARD OF MASSAGE THERAPY