Individual
RANDY TINGWALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
240 S MOUNT AUBURN RD, CAPE GIRARDEAU, MO 63703-4918
(573) 334-6711
Mailing address
33 KERN, BENTON, MO 63736-9221
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115998
LICENSE#
MO
Enumeration date
02/06/2007
Last updated
07/08/2007
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