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General NPI Number Information
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NPI Number | 1023746351
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Entity Type | Individual
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Provider Name | NICOLE CELINE RANDOLPH
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Gender | Female
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Dates
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Enumeration Date | 08/14/2022
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Last Update Date | 08/14/2022
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Provider Practice Location Address
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Address Line | 8988 S SHERIDAN RD STE Y
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City | TULSA
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State | OK
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Zip | 74133-5035
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Country | US
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Telephone | 918-265-4688
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Fax |
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Provider Business Mailing Address
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Address Line | 422 S VICTOR AVE
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City | TULSA
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State | OK
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Zip | 74104-2613
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Country | US
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Telephone | 918-729-2569
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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