=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326923640
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RIANNA STURDIVANT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2025
-----------------------------------------------------
Last Update Date | 08/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9730 W BLUEMOUND RD STE 23G
-----------------------------------------------------
City | WAUWATOSA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226-4463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-206-9836
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9092 N 75TH ST APT 1A
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53223-2028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-206-9836
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 17940-146
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------