Individual
MRS. CONNY CHRISTL RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
Contact information
Practice address
808 HWY 98 BYPASS, COLUMBIA, MS 39429-0429
(601) 731-1140
(601) 731-1148
Mailing address
571 PICKWICK ROAD, FOXWORTH, MS 39483
(601) 736-6617
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1635
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00121739
—
MS
Enumeration date
10/03/2006
Last updated
07/08/2007
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