Individual
MR. RANDOLPH TERRY BAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
3461 LAWRENCEVILLE SUWANEE RD, SUITE B, SUWANEE, GA 30024-6428
(815) 262-8563
Mailing address
3461 LAWRENCEVILLE SUWANEE RD, SUITE B, SUWANEE, GA 30024-6428
(815) 262-8563
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT010074
GA
Other
Enumeration date
09/16/2015
Last updated
09/16/2015
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