Healthcare Provider Details

I. General information

NPI: 1134718323
Provider Name (Legal Business Name): TONIA LATRELL REID LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 ROSWELL RD APT 21C1
MARIETTA GA
30068-3063
US

IV. Provider business mailing address

2010 ROSWELL RD APT 21C1
MARIETTA GA
30068-3063
US

V. Phone/Fax

Practice location:
  • Phone: 470-505-5416
  • Fax:
Mailing address:
  • Phone: 470-505-5416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT011591
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMT011591
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: