Provider Demographics
NPI:1851311682
Name:RANDLES, STEPHEN J (LMP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:RANDLES
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 36TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1312
Mailing Address - Country:US
Mailing Address - Phone:206-723-2820
Mailing Address - Fax:206-722-3664
Practice Address - Street 1:4236 36TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1312
Practice Address - Country:US
Practice Address - Phone:206-723-2820
Practice Address - Fax:206-722-3664
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012751225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0176408OtherLABOR AND INDUSTRIES