Individual
JEREMY RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
11330 MAPLE BROOK DR, LOUISVILLE, KY 40241-2080
(502) 426-2221
(502) 426-2210
Mailing address
11330 MAPLE BROOK DR, LOUISVILLE, KY 40241-2080
(502) 426-2221
(502) 426-2210
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
006908
KY
Other
Enumeration date
08/15/2016
Last updated
08/15/2016
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