MEDICARE: MRS. JAMIE RANDALL EUDY PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2466	NC

General Provider Information

NPI Number	:	1891039277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE RANDALL EUDY PTA

Provider Business Mailing Address
First Line	:	24724 S BUSINESS 52
Second Line	:
City	:	ALBEMARLE
State	:	NC
Zip	:	28001-8179
Country	:	US
Telephone Number	:	704-986-0862
Fax Number	:

Provider Business Practice Location Address
First Line	:	24724 S BUSINESS 52
Second Line	:
City	:	ALBEMARLE
State	:	NC
Zip	:	28001-8179
Country	:	US
Telephone Number	:	704-986-0862
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	11/26/2012

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