Provider Demographics
NPI:1891444394
Name:HILTON, KETRESIA (LMT, CMLDT)
Entity Type:Individual
Prefix:
First Name:KETRESIA
Middle Name:
Last Name:HILTON
Suffix:
Gender:F
Credentials:LMT, CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MASCOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:34753-9532
Mailing Address - Country:US
Mailing Address - Phone:267-290-7223
Mailing Address - Fax:
Practice Address - Street 1:1122 UNION AVE
Practice Address - Street 2:
Practice Address - City:MASCOTTE
Practice Address - State:FL
Practice Address - Zip Code:34753-9532
Practice Address - Country:US
Practice Address - Phone:267-290-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA98376225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist