MEDICARE: RANDOLPH NIGEL FREEMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	6070	AL

General Provider Information

NPI Number	:	1053189043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDOLPH NIGEL FREEMAN

Provider Business Mailing Address
First Line	:	1574 GULF SHORES PKWY
Second Line	:
City	:	GULF SHORES
State	:	AL
Zip	:	36542-3414
Country	:	US
Telephone Number	:	251-272-9191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1574 GULF SHORES PKWY
Second Line	:
City	:	GULF SHORES
State	:	AL
Zip	:	36542-3414
Country	:	US
Telephone Number	:	251-272-9191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	12/19/2023

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Directions to “ RANDOLPH NIGEL FREEMAN ” Practice Location

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