Provider Demographics
NPI:1790376457
Name:WASHINGTON, LATRICE (LMT)
Entity Type:Individual
Prefix:
First Name:LATRICE
Middle Name:
Last Name:WASHINGTON
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 1:3311 W WYOMING CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-4337
Mailing Address - Country:US
Mailing Address - Phone:813-831-8880
Mailing Address - Fax:
Practice Address - Street 1:3311 W WYOMING CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-4337
Practice Address - Country:US
Practice Address - Phone:813-831-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA92680225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist