Provider Demographics
NPI:1245858133
Name:PLATER, LORETTA VANESSA (LMT)
Entity type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:VANESSA
Last Name:PLATER
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 1:1805 W LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-1635
Mailing Address - Country:US
Mailing Address - Phone:443-865-1754
Mailing Address - Fax:
Practice Address - Street 1:3101 FALLSTAFF RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2967
Practice Address - Country:US
Practice Address - Phone:443-865-1754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM06038225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist