Provider Demographics
NPI:1942694674
Name:CHRISTENSEN, RANDI LEA (ATC)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:LEA
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57383-0232
Mailing Address - Country:US
Mailing Address - Phone:605-249-2188
Mailing Address - Fax:
Practice Address - Street 1:1200 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4358
Practice Address - Country:US
Practice Address - Phone:605-995-2319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer