Provider Demographics
NPI:1730807819
Name:HASKINS, LATRIECE (ATC, MFP-C)
Entity type:Individual
Prefix:MS
First Name:LATRIECE
Middle Name:
Last Name:HASKINS
Suffix:
Gender:F
Credentials:ATC, MFP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5648 DARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-4610
Mailing Address - Country:US
Mailing Address - Phone:804-484-9461
Mailing Address - Fax:
Practice Address - Street 1:5924 VICTORIA PARK WAY
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-5294
Practice Address - Country:US
Practice Address - Phone:804-484-9461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA88363642224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA88363642OtherMEDICAL FITNESS PRACTITIONER LICENSE NUMBER