Provider Demographics
NPI:1639695679
Name:REID, RITA (LMT, BCTMB)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:LMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 MAYEUX ST
Mailing Address - Street 2:
Mailing Address - City:MOREAUVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71355-2900
Mailing Address - Country:US
Mailing Address - Phone:318-597-1188
Mailing Address - Fax:
Practice Address - Street 1:254 MAYEUX ST
Practice Address - Street 2:
Practice Address - City:MOREAUVILLE
Practice Address - State:LA
Practice Address - Zip Code:71355-2900
Practice Address - Country:US
Practice Address - Phone:318-597-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA8392225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist