Provider Demographics
NPI:1417402322
Name:RILEY, LATOYA NICOLE (LMT, MMP)
Entity Type:Individual
Prefix:MISS
First Name:LATOYA
Middle Name:NICOLE
Last Name:RILEY
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 ISAAC ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-5020
Mailing Address - Country:US
Mailing Address - Phone:803-608-5231
Mailing Address - Fax:
Practice Address - Street 1:408 ISAAC ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5020
Practice Address - Country:US
Practice Address - Phone:803-608-5231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7319225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist