Provider Demographics
NPI:1215170261
Name:WEIST, RANDALL C (LMT)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:C
Last Name:WEIST
Suffix:
Gender:M
Credentials:LMT
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Mailing Address - Street 1:145 CITIZENS LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1320
Mailing Address - Country:US
Mailing Address - Phone:606-435-7690
Mailing Address - Fax:606-439-0778
Practice Address - Street 1:145 CITIZENS LN
Practice Address - Street 2:SUITE B
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1320
Practice Address - Country:US
Practice Address - Phone:606-435-7690
Practice Address - Fax:606-439-0778
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYKY-2464225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist