Provider Demographics
NPI:1265786735
Name:JONES, RANDALL ELLIOTT (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:ELLIOTT
Last Name:JONES
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 NE 16TH CT.
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4666
Mailing Address - Country:US
Mailing Address - Phone:360-666-6870
Mailing Address - Fax:
Practice Address - Street 1:1606 NE 16TH CT
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4666
Practice Address - Country:US
Practice Address - Phone:360-666-6870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60110921174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist