Healthcare Provider Details

I. General information

NPI: 1457719346
Provider Name (Legal Business Name): RANDY TRUMBOWER P.T., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CLIFTON RD NE
ATLANTA GA
30322-0001
US

IV. Provider business mailing address

235 IVY PARK SQ
AVONDALE ESTATES GA
30002-1773
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-3065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT009764
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: