Provider Demographics
NPI:1730211582
Name:VANDENOVER, RANDAE MARIE (LMT)
Entity type:Individual
Prefix:MS
First Name:RANDAE
Middle Name:MARIE
Last Name:VANDENOVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 FINLANDIA LN APT 19
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-3346
Mailing Address - Country:US
Mailing Address - Phone:727-796-2905
Mailing Address - Fax:
Practice Address - Street 1:531 MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3558
Practice Address - Country:US
Practice Address - Phone:727-799-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA31820225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist