Provider Demographics
NPI:1679188510
Name:TOOLES, RALONDA
Entity Type:Individual
Prefix:
First Name:RALONDA
Middle Name:
Last Name:TOOLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 OAKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-1234
Mailing Address - Country:US
Mailing Address - Phone:678-693-0433
Mailing Address - Fax:
Practice Address - Street 1:1010 OAKHAVEN DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-1234
Practice Address - Country:US
Practice Address - Phone:678-693-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GART010191225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist