Provider Demographics
NPI:1124207238
Name:MUSLADIN, RANDALL TY
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:TY
Last Name:MUSLADIN
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 1:6815 FIVE STAR BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2688
Mailing Address - Country:US
Mailing Address - Phone:916-630-1215
Mailing Address - Fax:916-630-7616
Practice Address - Street 1:6815 FIVE STAR BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2688
Practice Address - Country:US
Practice Address - Phone:916-630-1215
Practice Address - Fax:916-630-7616
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist