Provider Demographics
NPI:1578809950
Name:RANDALL, CHRISTY LYN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:LYN
Last Name:RANDALL
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-3717
Mailing Address - Country:US
Mailing Address - Phone:503-522-9265
Mailing Address - Fax:
Practice Address - Street 1:936 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-3717
Practice Address - Country:US
Practice Address - Phone:503-522-9265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19501172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker