Individual
JEREMIAH THOMAS RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1336 N WALNUT ST, IOLA, KS 66749-1601
(620) 365-6989
Mailing address
10684 W 825 RD, MOUND CITY, KS 66056-9112
(913) 645-0264
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
11-04026
KS
2251S0007X
Sports Physical Therapist
24988
FL
Other
Enumeration date
11/21/2009
Last updated
11/21/2009
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