Provider Demographics
NPI:1043871130
Name:REYNOLDS, LAKIA (LMT)
Entity type:Individual
Prefix:
First Name:LAKIA
Middle Name:
Last Name:REYNOLDS
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 1:5550 W 10TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-6243
Mailing Address - Country:US
Mailing Address - Phone:317-672-2644
Mailing Address - Fax:463-800-1728
Practice Address - Street 1:5550 W 10TH ST STE D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-6243
Practice Address - Country:US
Practice Address - Phone:317-672-2644
Practice Address - Fax:463-800-1728
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21304955225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist