Provider Demographics
NPI:1568899680
Name:RIDESATTHEDOOR, DARNELL ELAINE (CMT,LMT, REIKI 3)
Entity Type:Individual
Prefix:MS
First Name:DARNELL
Middle Name:ELAINE
Last Name:RIDESATTHEDOOR
Suffix:
Gender:F
Credentials:CMT,LMT, REIKI 3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:#1 SPRINGHILL RANCH RD.
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417-0367
Mailing Address - Country:US
Mailing Address - Phone:406-338-2607
Mailing Address - Fax:
Practice Address - Street 1:#1 SPRINGHILL RANCH RD.
Practice Address - Street 2:
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417-0367
Practice Address - Country:US
Practice Address - Phone:406-338-2607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT#179171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT#179OtherMASSAGE THERAPY