Healthcare Provider Details

I. General information

NPI: 1407280340
Provider Name (Legal Business Name): RANDOLPH SPECIALTY GROUP PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N FAYETTEVILLE ST
ASHEBORO NC
27203-4728
US

IV. Provider business mailing address

PO BOX 5418
ASHEBORO NC
27204-5418
US

V. Phone/Fax

Practice location:
  • Phone: 336-626-3700
  • Fax: 336-626-6453
Mailing address:
  • Phone: 336-625-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT CLAUSER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-625-2333