Provider Demographics
NPI:1619355799
Name:MORRIS, RANDAL STEELE (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:RANDAL
Middle Name:STEELE
Last Name:MORRIS
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 PROVIDENCE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-9048
Mailing Address - Country:US
Mailing Address - Phone:803-460-3895
Mailing Address - Fax:
Practice Address - Street 1:526 PROVIDENCE CROSSING DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9048
Practice Address - Country:US
Practice Address - Phone:803-460-3895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer