Individual
RANDY MC COLLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
101 CLEVELAND AVE, MARTINSVILLE, VA 24112-3700
(276) 233-6752
Mailing address
101 CLEVELAND AVE STE D, MARTINSVILLE, VA 24112-3700
(276) 233-6752
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
2305002268
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2305002268
STATE OF VIRGINIA
VA
Enumeration date
01/22/2018
Last updated
01/22/2018
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