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General NPI Number Information
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NPI Number | 1467460568
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Entity Type | Individual
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Provider Name | CHRISTOPHER BLAKE RANDLE MS, PT.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4101 WESLEY ST SUITE H
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City | GREENVILLE
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State | TX
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Zip | 75401-5635
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Country | US
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Telephone | 903-454-8100
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Fax | 903-454-1180
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Provider Business Mailing Address
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Address Line | 102 SPRINGFIELD DRIVE
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City | COOPER
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State | TX
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Zip | 75432
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Country | US
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Telephone | 903-395-4835
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Fax | 903-886-7679
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1151637
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License Number State | TX
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