Individual
KELLY GENE RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1726 BECK AVE, CODY, WY 82414-3925
(307) 587-9866
(307) 587-9867
Mailing address
1726 BECK AVE, CODY, WY 82414-3925
(307) 587-9866
(307) 587-9867
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1256
WY
Other
Enumeration date
09/30/2008
Last updated
09/30/2008
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