Individual
RANDELL ROSHAUN KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
508 PIERCE ST, LINDALE, TX 75771-3335
(903) 881-9373
Mailing address
410 BAKER ST, LINDALE, TX 75771-6286
(903) 316-3253
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2059006
TX
Other
Enumeration date
08/24/2018
Last updated
08/24/2018
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