Healthcare Provider Details

I. General information

NPI: 1407710304
Provider Name (Legal Business Name): MISS TIFFONI LATOYA MOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 S BECKLEY AVE STE 225
DALLAS TX
75224-3528
US

IV. Provider business mailing address

2629 S GRAND PENINSULA DR APT 204
GRAND PRAIRIE TX
75054-7299
US

V. Phone/Fax

Practice location:
  • Phone: 682-351-2258
  • Fax:
Mailing address:
  • Phone: 682-351-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT135485
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: