Provider Demographics
NPI:1023714995
Name:ADADE, KISHA T (RYT 200 TRAINING)
Entity type:Individual
Prefix:
First Name:KISHA
Middle Name:T
Last Name:ADADE
Suffix:
Gender:F
Credentials:RYT 200 TRAINING
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1285 SWAMP RD SE
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:GA
Mailing Address - Zip Code:31331-4235
Mailing Address - Country:US
Mailing Address - Phone:912-424-4643
Mailing Address - Fax:
Practice Address - Street 1:1285 SWAMP RD SE
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:GA
Practice Address - Zip Code:31331-4235
Practice Address - Country:US
Practice Address - Phone:912-424-4643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA394581225CX0006X, 373H00000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
394581OtherYOGA ALLIANCE