Organization Name: | RANDA AND WAHL, A PHYSICAL THERAPY CORP. |
NPI Number: | 1194802306 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JACQUELINE RANDA (PRESIDENT) |
Mailing Address: | 1815 E Main St Barstow |
State: | CA US |
Postal Code: | 923113234 |
Phone Number: | 7602562800 |
Fax Number: | 7602562809 |
NPI Enumeration Date: | 11/01/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | PT 25062 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |