Provider Demographics
NPI:1679014989
Name:RILEY, SHAQUITA (LMT)
Entity Type:Individual
Prefix:
First Name:SHAQUITA
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 S LANGLEY AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-3432
Mailing Address - Country:US
Mailing Address - Phone:773-344-8353
Mailing Address - Fax:
Practice Address - Street 1:6410 S LANGLEY AVE
Practice Address - Street 2:APT 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-3432
Practice Address - Country:US
Practice Address - Phone:773-344-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.019640225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist