Individual
MR. TERRY L RANDALL
Active
Individual
MR. TERRY L RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
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
Update your record
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