Provider Demographics
NPI:1477364214
Name:RIEDEL, RENEE (LMT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:RIEDEL
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 1:8804 W 88TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-3610
Mailing Address - Country:US
Mailing Address - Phone:913-271-4069
Mailing Address - Fax:
Practice Address - Street 1:9270 METCALF AVE.
Practice Address - Street 2:SUITE 118
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1478
Practice Address - Country:US
Practice Address - Phone:913-543-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSTHR-068271225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist