Individual
RANDALL J SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
107 N PINE ST STE A, PITTSBURG, KS 66762-4743
(620) 231-5855
(620) 231-5906
Mailing address
107 N PINE ST STE A, PO BOX 1539, PITTSBURG, KS 66762-4743
(620) 231-5855
(620) 231-5906
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-02934
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140949
KS BCBS
KS
05
—
463291
—
KS
01
—
P00287507
KS MEDICARE RAILROAD
KS
Enumeration date
08/30/2006
Last updated
12/06/2007
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