Provider Demographics
NPI:1487420147
Name:PIERCE, LATRISHA K (MT-23990)
Entity type:Individual
Prefix:
First Name:LATRISHA
Middle Name:K
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MT-23990
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2394 E CAMELBACK RD STE 120
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3464
Mailing Address - Country:US
Mailing Address - Phone:602-688-9270
Mailing Address - Fax:
Practice Address - Street 1:2394 E CAMELBACK RD STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3464
Practice Address - Country:US
Practice Address - Phone:602-688-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-23990225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist