Individual
RANDALL E BOLDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1008 W 35TH ST, DAVENPORT, IA 52806-5827
(563) 324-2263
(563) 324-0719
Mailing address
850 43RD AVE STE 100, MOLINE, IL 61265-8401
(309) 743-2070
(309) 743-2073
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02562
IA
225100000X
Physical Therapist
070-008667
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02562
IOWA PT LICENSE NUMBER
IA
01
—
070-008667
ILLINOIS PT LICENSE NO.
IL
Enumeration date
05/01/2006
Last updated
09/23/2013
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