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General NPI Number Information
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NPI Number | 1225576606
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Entity Type | Individual
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Provider Name | JONATHAN BERNARD RANDLE PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 06/21/2025
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Provider Practice Location Address
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Address Line | 11100 HIGHWAY 165 STE 5
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72117-9781
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Country | US
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Telephone | 501-945-0200
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Fax | 501-945-0245
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Provider Business Mailing Address
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Address Line | PO BOX 5718
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City | KALISPELL
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State | MT
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Zip | 59903-5718
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Country | US
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Telephone | 406-756-0134
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Fax | 406-300-1612
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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 | CP017265T
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4262
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License Number State | AR
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