Provider Demographics
NPI:1730594391
Name:LASIDA, RICARDO TLMT
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:TLMT
Last Name:LASIDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 GRAYSON LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5857
Mailing Address - Country:US
Mailing Address - Phone:832-428-7455
Mailing Address - Fax:
Practice Address - Street 1:20527 FM 1093 RD
Practice Address - Street 2:B202
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-9514
Practice Address - Country:US
Practice Address - Phone:832-428-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT011526225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist