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General NPI Number Information
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NPI Number | 1841981164
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Entity Type | Individual
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Provider Name | LATRINA GRIFFIN
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Gender | Female
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 115 N MARION ST STE 8
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City | OAK PARK
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State | IL
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Zip | 60301-1503
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Country | US
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Telephone | 773-915-3683
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Fax |
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Provider Business Mailing Address
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Address Line | 1719 N LUNA AVE
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City | CHICAGO
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State | IL
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Zip | 60639-4225
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227012094
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License Number State | IL
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