Provider Demographics
NPI:1205256633
Name:PILLARS, RHYDONIA R (LMT, NCTMB)
Entity type:Individual
Prefix:MS
First Name:RHYDONIA
Middle Name:R
Last Name:PILLARS
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 BERT KOUNS INDUSTRIAL LOOP # 11
Mailing Address - Street 2:STE G
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2948
Mailing Address - Country:US
Mailing Address - Phone:318-686-1186
Mailing Address - Fax:318-686-1053
Practice Address - Street 1:3110 BERT KOUNS INDUSTRIAL LOOP # 11
Practice Address - Street 2:STE G
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2948
Practice Address - Country:US
Practice Address - Phone:318-686-1186
Practice Address - Fax:318-686-1053
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA4540174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist