Provider Demographics
NPI:1700321379
Name:STRAND, RANDY (LMT, NAC)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:STRAND
Suffix:
Gender:M
Credentials:LMT, NAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 196TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-3431
Mailing Address - Country:US
Mailing Address - Phone:253-414-5100
Mailing Address - Fax:
Practice Address - Street 1:7504 86TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-6176
Practice Address - Country:US
Practice Address - Phone:253-212-2036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60809618172M00000X, 225700000X
WANC10081827376K00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No172M00000XOther Service ProvidersMechanotherapist
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA207045001OtherDSHS- HOME & COMMUNITY SERVICES, AGING & LONG-TERM SUPPORT ADMINISTRATION