Provider Demographics
NPI:1992312987
Name:RIKARD, LOUISE THACKSTON
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:THACKSTON
Last Name:RIKARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 RUSSELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:SPEEDWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37870-7161
Mailing Address - Country:US
Mailing Address - Phone:606-242-1995
Mailing Address - Fax:
Practice Address - Street 1:483 RUSSELL HILL RD
Practice Address - Street 2:
Practice Address - City:SPEEDWELL
Practice Address - State:TN
Practice Address - Zip Code:37870-7161
Practice Address - Country:US
Practice Address - Phone:606-242-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8485225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist