Individual
RANDI SU SMALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2344 E SIERRA ST, PHOENIX, AZ 85028-1716
(641) 777-8248
Mailing address
2344 E SIERRA ST, PHOENIX, AZ 85028-1716
(641) 777-8248
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
8368A
AZ
261QP2000X
Physical Therapy Clinic/Center
8368A
AZ
Other
Enumeration date
06/10/2018
Last updated
06/10/2018
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