Healthcare Provider Details

I. General information

NPI: 1205585197
Provider Name (Legal Business Name): TAMEKA ENOCH LMBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMEKA ROGERS LMBT

II. Dates (important events)

Enumeration Date: 03/20/2022
Last Update Date: 03/20/2022
Certification Date: 03/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 W MILLBROOK RD STE 131
RALEIGH NC
27609-4394
US

IV. Provider business mailing address

312 WOODS RUN
KNIGHTDALE NC
27545-7404
US

V. Phone/Fax

Practice location:
  • Phone: 919-272-7419
  • Fax:
Mailing address:
  • Phone: 919-272-7419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6848
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: