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Individual

MR. TERRY L RANDALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
175 MEDPARK DR, SOMERSET, KY 42503-2734
(606) 679-1761
(606) 678-0971
Mailing address
175 MEDPARK DR, SOMERSET, KY 42503-2734
(606) 679-1761
(606) 678-0971

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
003180
KY
2255A2300X
Athletic Trainer
AT361
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000225912
BCBS PROVIDER NUMBER
KY
05
87031803
KY
Enumeration date
07/12/2006
Last updated
07/16/2014
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