Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 6094 | AZ |
N | 2251G0304X | Physical Therapist - Geriatrics | 6094 | AZ |
N | 2251X0800X | Physical Therapist - Orthopedic | 6094 | AZ |
NPI | 1255376240 |
---|---|
Provider Name | Milton Gregory Randall |
First Address | Show Low, AZ 85902-0457 |
Second Address | Show Low, AZ 85901-7823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 16/09/2015 |