Provider Demographics
NPI:1497575096
Name:TANCREDE, LATOYA (LMT)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:TANCREDE
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 1:5008 JOSEPH DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6217
Mailing Address - Country:US
Mailing Address - Phone:512-619-5191
Mailing Address - Fax:
Practice Address - Street 1:1509 W STAN SCHLUETER LOOP
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-3679
Practice Address - Country:US
Practice Address - Phone:254-232-6522
Practice Address - Fax:254-488-3110
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128863225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist