Provider Demographics
NPI:1932717444
Name:RYLES, JUDY DEMARIS (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:DEMARIS
Last Name:RYLES
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 1:1344 GREENE ROAD 503
Mailing Address - Street 2:
Mailing Address - City:LAFE
Mailing Address - State:AR
Mailing Address - Zip Code:72436-9033
Mailing Address - Country:US
Mailing Address - Phone:870-212-0366
Mailing Address - Fax:
Practice Address - Street 1:4709 W KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-3490
Practice Address - Country:US
Practice Address - Phone:870-565-2232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7083225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist