Provider Demographics
NPI:1225734288
Name:BERRY, NIKEA SHANAY (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:NIKEA
Middle Name:SHANAY
Last Name:BERRY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 RIVERCHASE WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9468
Mailing Address - Country:US
Mailing Address - Phone:803-467-8671
Mailing Address - Fax:
Practice Address - Street 1:141 RIVERCHASE WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9468
Practice Address - Country:US
Practice Address - Phone:803-467-8671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11416225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist