Provider Demographics
NPI:1245625995
Name:RANDLE, LATIFFIA
Entity type:Individual
Prefix:
First Name:LATIFFIA
Middle Name:
Last Name:RANDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 MASSACHUSETTS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77029-4738
Mailing Address - Country:US
Mailing Address - Phone:832-816-2013
Mailing Address - Fax:
Practice Address - Street 1:3453 N IH 35 STE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78219-2337
Practice Address - Country:US
Practice Address - Phone:210-293-3111
Practice Address - Fax:210-293-3110
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2090381225200000X
VA2306603450225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant