Provider Demographics
NPI:1184956781
Name:MEDCALF, RANDALL (LMT)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:
Last Name:MEDCALF
Suffix:
Gender:M
Credentials:LMT
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 11431
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77391-1431
Mailing Address - Country:US
Mailing Address - Phone:713-482-7037
Mailing Address - Fax:
Practice Address - Street 1:16903 RED OAK DR
Practice Address - Street 2:SUITE 165
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3914
Practice Address - Country:US
Practice Address - Phone:713-482-7037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109817225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist