Provider Demographics
NPI:1902533425
Name:MARSDEN, RANDALL JOHN (LMT)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:JOHN
Last Name:MARSDEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3986 HALTER LN
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6173
Mailing Address - Country:US
Mailing Address - Phone:858-378-6395
Mailing Address - Fax:
Practice Address - Street 1:2045 ASHER CT STE 100
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8444
Practice Address - Country:US
Practice Address - Phone:517-351-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501014902225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist