Provider Demographics
NPI:1467460568
Name:RANDLE, CHRISTOPHER BLAKE (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:BLAKE
Last Name:RANDLE
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SPRINGFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:COOPER
Mailing Address - State:TX
Mailing Address - Zip Code:75432
Mailing Address - Country:US
Mailing Address - Phone:903-395-4835
Mailing Address - Fax:903-886-7679
Practice Address - Street 1:4101 WESLEY ST
Practice Address - Street 2:SUITE H
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5635
Practice Address - Country:US
Practice Address - Phone:903-454-8100
Practice Address - Fax:903-454-1180
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T1324OtherBCBS PROVIDER