Individual
DEANNA RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1801 S 74TH ST, FORT SMITH, AR 72903-2814
(479) 928-0128
Mailing address
1801 S 74TH ST, FORT SMITH, AR 72903-2814
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2650
AR
Other
Enumeration date
09/05/2012
Last updated
09/05/2012
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