Provider Demographics
NPI:1225912918
Name:STANLEY, ELISA RANDI (LMT)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:RANDI
Last Name:STANLEY
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 1:19 LANDMARK DR APT 39B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4544
Mailing Address - Country:US
Mailing Address - Phone:443-221-9782
Mailing Address - Fax:
Practice Address - Street 1:403 E MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3603
Practice Address - Country:US
Practice Address - Phone:443-221-9782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13317225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist