Provider Demographics
NPI:1679619670
Name:HARWOOD, RANDI COLLEEN (LMT)
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:COLLEEN
Last Name:HARWOOD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 3RD ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-1547
Mailing Address - Country:US
Mailing Address - Phone:425-280-1081
Mailing Address - Fax:425-903-4128
Practice Address - Street 1:716 3RD ST UNIT B
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-1547
Practice Address - Country:US
Practice Address - Phone:425-280-1081
Practice Address - Fax:425-903-4128
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 16902225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA303197100000Medicare UPIN