Provider Demographics
NPI:1154928414
Name:RIDEAU, LATOYA VIKAL (LMT)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:VIKAL
Last Name:RIDEAU
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 1:3651 LANDERS LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3830
Mailing Address - Country:US
Mailing Address - Phone:337-351-0365
Mailing Address - Fax:
Practice Address - Street 1:3651 LANDERS LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3830
Practice Address - Country:US
Practice Address - Phone:337-351-0365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116127225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist