Individual
AMANDA RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, MED
Contact information
Practice address
217 FANEUIL ST, BRIGHTON, MA 02135-1811
(603) 312-5051
Mailing address
217 FANEUIL ST, BRIGHTON, MA 02135-1811
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2359
MA
Other
Enumeration date
05/04/2015
Last updated
05/04/2015
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