Provider Demographics
NPI:1184991770
Name:KNIGHT, RANDAL C (LMP)
Entity type:Individual
Prefix:
First Name:RANDAL
Middle Name:C
Last Name:KNIGHT
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 1:14609 NE 64TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4635
Mailing Address - Country:US
Mailing Address - Phone:425-941-7678
Mailing Address - Fax:
Practice Address - Street 1:14609 NE 64TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4635
Practice Address - Country:US
Practice Address - Phone:425-941-7678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-26
Last Update Date:2011-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60234017225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist