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General NPI Number Information
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NPI Number | 1336688092
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Entity Type | Individual
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Provider Name | MELISSA RANDALL PT,DPT,SCS
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Gender | Female
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 1811 PLAZA DR
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-2450
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Country | US
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Telephone | 720-478-0417
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 PLAZA DR
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-2450
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Country | US
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Telephone |
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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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | PTL0011302
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License Number State | CO
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