Provider Demographics
NPI:1790369056
Name:RIENDEAU, RACHAEL (LMT)
Entity type:Individual
Prefix:MISS
First Name:RACHAEL
Middle Name:
Last Name:RIENDEAU
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:RAE
Other - Middle Name:
Other - Last Name:RIENDEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:1118 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2957
Mailing Address - Country:US
Mailing Address - Phone:971-371-6172
Mailing Address - Fax:
Practice Address - Street 1:1118 14TH AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2957
Practice Address - Country:US
Practice Address - Phone:971-371-6172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-2814225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist