Provider Demographics
NPI:1336341775
Name:CROSS, LATICHIA GAIL (LMT)
Entity Type:Individual
Prefix:MISS
First Name:LATICHIA
Middle Name:GAIL
Last Name:CROSS
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 1:8704 JACKSON HWY
Mailing Address - Street 2:
Mailing Address - City:CAVE CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42127-9168
Mailing Address - Country:US
Mailing Address - Phone:270-773-7182
Mailing Address - Fax:
Practice Address - Street 1:220 MAMMOTH CAVE STREET
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:KY
Practice Address - Zip Code:42127
Practice Address - Country:US
Practice Address - Phone:270-773-7182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0218225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist