Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PTL0011302 | CO |
NPI | 1336688092 |
---|---|
Provider Name | Melissa Randall |
First Address | Highlands Ranch, CO 80129-2450 |
Second Address | Highlands Ranch, CO 80129-2450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2017 |
Last Update Date | 14/02/2017 |