Individual
MR. RANDALL L HARATYK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
600 RINCON RD, CORRALES, NM 87048-7651
(505) 899-1509
(505) 890-7380
Mailing address
600 RINCON RD, CORRALES, NM 87048-7651
(505) 899-1509
(505) 890-7380
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2240
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OOQ464
BCBS PROVIDER #
NM
Enumeration date
07/29/2006
Last updated
07/08/2007
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