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General NPI Number Information
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NPI Number | 1497369631
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Entity Type | Individual
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Provider Name | JUSTIN A RAND L.M.T
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Gender | Male
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 88 W COLT SQUARE DR, FAYETTEVILLE, AR 72703
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City | FAYETTEVILLE
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State | AR
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Zip | 72703
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Country | US
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Telephone | 479-444-9449
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Fax | 479-444-9403
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Provider Business Mailing Address
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Address Line | 3959 N STEELE BLVD #517
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City | FAYETTEVILLE
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State | AR
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Zip | 72703
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Country | US
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Telephone | 850-512-8887
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | ADH13462189
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA37867
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License Number State | FL
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