Healthcare Provider Details

I. General information

NPI: 1336050913
Provider Name (Legal Business Name): LATASHA K GROGAN MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 NEW CUT RD
PIEDMONT SC
29673-7816
US

IV. Provider business mailing address

17 TRANQUIL DAY DR
PIEDMONT SC
29673-6596
US

V. Phone/Fax

Practice location:
  • Phone: 864-525-6117
  • Fax:
Mailing address:
  • Phone: 864-525-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11660
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: