Healthcare Provider Details

I. General information

NPI: 1720076516
Provider Name (Legal Business Name): RANDY J TOTH PT, LAT, ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20500 SENECA MEADOWS PKWY SUITE 101
GERMANTOWN MD
20876-7008
US

IV. Provider business mailing address

20805 SHAMROCK GLEN CIR
GERMANTOWN MD
20874-3976
US

V. Phone/Fax

Practice location:
  • Phone: 301-916-8500
  • Fax: 301-528-6258
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number24220
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: