Individual
MS. ANNE MELISSA RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
4091 CORALEE LN, LAFAYETTE, CA 94549-3311
(925) 283-1927
(925) 283-1926
Mailing address
4091 CORALEE LN, LAFAYETTE, CA 94549-3311
(925) 283-1927
(925) 283-1926
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9002
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
94-3346779
TAX IDENTIFICATION NUMBER
CA
Enumeration date
11/01/2006
Last updated
07/08/2007
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