Individual
MR. RANDALL W JERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2700 VINE ST, EL DORADO, AR 71730-6700
(870) 875-5124
(870) 875-5198
Mailing address
PO BOX 10730, EL DORADO, AR 71730-0028
(870) 875-5124
(870) 875-5198
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4326
AR
Other
Enumeration date
08/08/2017
Last updated
07/22/2020
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