Healthcare Provider Details

I. General information

NPI: 1316381957
Provider Name (Legal Business Name): KYLA BRIANNE RANDALL L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 PIONEER ST STE A
ENUMCLAW WA
98022-2299
US

IV. Provider business mailing address

24226 SE 378TH ST
ENUMCLAW WA
98022-8866
US

V. Phone/Fax

Practice location:
  • Phone: 360-825-5757
  • Fax:
Mailing address:
  • Phone: 425-623-5939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA.60317077
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: