Provider Demographics
NPI:1205122082
Name:THOLL, RANDY (NCTM)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:THOLL
Suffix:
Gender:M
Credentials:NCTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 HIDDEN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-8755
Mailing Address - Country:US
Mailing Address - Phone:775-250-4543
Mailing Address - Fax:775-857-1585
Practice Address - Street 1:5270 LONGLEY LN
Practice Address - Street 2:SUITE 106
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2297
Practice Address - Country:US
Practice Address - Phone:775-250-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.3614225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist