Doctor Name: | JEREMIAH THOMAS RANDALL |
NPI Number: | 1366770828 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | 24988 |
Business Practice Address: | 1336 N Walnut St Iola, KS - 667491601 |
Business Phone Number: | 6203656989 |
Business Fax Number: | |
Mailing Address: | 10684 W 825 Rd, MOUND CITY |
State: | KS |
Postal Code: | 660569112 |
Phone Number: | 9136450264 |
Fax Number: | |
NPI Enumeration Date: | 11/21/2009 |
NPI Last Update Date: | 11/21/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251S0007X |
License Number: | 24988 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Sports |
Taxonomy Definition: |