Individual
MR. RANDELL BLAKE WADDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
6793 MASSA LN, FRISCO, TX 75034-2285
(806) 236-9452
Mailing address
6793 MASSA LN, FRISCO, TX 75034-2285
(806) 236-9452
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT132657
TX
Other
Enumeration date
04/03/2020
Last updated
04/08/2020
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