Provider Demographics
NPI:1780373845
Name:LAKIN, RILEY (DPT)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:LAKIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 PLANTATION HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078-2838
Mailing Address - Country:US
Mailing Address - Phone:318-775-9870
Mailing Address - Fax:318-775-9884
Practice Address - Street 1:318 PLANTATION HILLS BLVD
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078-2838
Practice Address - Country:US
Practice Address - Phone:318-775-9870
Practice Address - Fax:318-775-9884
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist