Healthcare Provider Details

I. General information

NPI: 1912599408
Provider Name (Legal Business Name): RANDALL ULANGCA PA-C, PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2021
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 TREASURY DR APT J
DAYTON OH
45429-6238
US

IV. Provider business mailing address

729 TREASURY DR APT J
DAYTON OH
45429-6238
US

V. Phone/Fax

Practice location:
  • Phone: 720-357-5838
  • Fax:
Mailing address:
  • Phone: 720-357-5838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008467RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018530
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: