Provider Demographics
NPI:1750765525
Name:ADAMS, RISHARIA TYESHEKA (LMP)
Entity type:Individual
Prefix:
First Name:RISHARIA
Middle Name:TYESHEKA
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14195 KIPLING AVE S
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2610
Mailing Address - Country:US
Mailing Address - Phone:651-726-4056
Mailing Address - Fax:952-882-2978
Practice Address - Street 1:14195 KIPLING AVE S
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2610
Practice Address - Country:US
Practice Address - Phone:651-726-4056
Practice Address - Fax:952-882-2978
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-12
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4334225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty