Provider Demographics
NPI:1104548338
Name:ANDERSON, LATIFA KWAYIS
Entity type:Individual
Prefix:MS
First Name:LATIFA
Middle Name:KWAYIS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 METAIRIE LAWN DR STE 202
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6141
Mailing Address - Country:US
Mailing Address - Phone:504-236-8648
Mailing Address - Fax:
Practice Address - Street 1:2628 METAIRIE LAWN DR STE 202
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6141
Practice Address - Country:US
Practice Address - Phone:504-236-8648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA2918225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist