Provider Demographics
NPI:1578391157
Name:LOWE, LARHESHA D'SHAE (LMT)
Entity type:Individual
Prefix:
First Name:LARHESHA
Middle Name:D'SHAE
Last Name:LOWE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LARHESHA
Other - Middle Name:D'SHAE
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2818 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-3021
Mailing Address - Country:US
Mailing Address - Phone:510-776-7921
Mailing Address - Fax:
Practice Address - Street 1:350 LOCUST DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-4281
Practice Address - Country:US
Practice Address - Phone:707-553-2698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94974225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist