Provider Demographics
NPI:1073245841
Name:RILEY ORTHOPEDIC AND MEDICAL MASSAGE, LLC
Entity Type:Organization
Organization Name:RILEY ORTHOPEDIC AND MEDICAL MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, MMP
Authorized Official - Phone:803-917-2695
Mailing Address - Street 1:7132 PARKLANE RD STE D
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7643
Mailing Address - Country:US
Mailing Address - Phone:803-917-2695
Mailing Address - Fax:
Practice Address - Street 1:7132 PARKLANE RD STE D
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7643
Practice Address - Country:US
Practice Address - Phone:803-917-2695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty