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General NPI Number Information
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NPI Number | 1134153976
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Entity Type | Individual
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Provider Name | WILLIAM THOMAS RAND JR. P.T.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3089 TAMIAMI TRAIL
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952
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Country | US
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Telephone | 941-662-0196
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Fax |
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Provider Business Mailing Address
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Address Line | 15504 ARIBE AVE
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City | PORT CHARLOTTE
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State | FL
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Zip | 33981-4251
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Country | US
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Telephone | 941-697-1839
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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 | 20689
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License Number State | FL
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