Healthcare Provider Details

I. General information

NPI: 1659264257
Provider Name (Legal Business Name): LARITA BUCKHANAS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 SHADY TRL # 470
DALLAS TX
75229-4617
US

IV. Provider business mailing address

2329 EDENBORN AVE
METAIRIE LA
70001-1815
US

V. Phone/Fax

Practice location:
  • Phone: 214-807-6778
  • Fax: 888-830-8403
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT029655
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: