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NPI Code Detail

MEDICARE: RANDIE L FLETCHER LMT

MEDICARE:   RANDIE L FLETCHER  LMT
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
1225700000XMassage Therapist9823CO

General Provider Information

NPI Number : 1235442104
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDIE L FLETCHER LMT
Provider Business Mailing Address
First Line : 31 N TEJON ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80903-1523
Country : US
Telephone Number : 719-632-6192
Fax Number :
Provider Business Practice Location Address
First Line : 31 N TEJON ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80903-1523
Country : US
Telephone Number : 719-632-6192
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2010
Last Update Date : 07/21/2010

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Directions to “ RANDIE L FLETCHER LMT” Practice Location

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