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General NPI Number Information
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NPI Number | 1407280340
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Entity Type | Organization
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Legal Business Name | RANDOLPH SPECIALTY GROUP PRACTICE
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Dates
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Enumeration Date | 08/28/2013
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 503 N FAYETTEVILLE ST
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City | ASHEBORO
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State | NC
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Zip | 27203-4728
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Country | US
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Telephone | 336-626-3700
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Fax | 336-626-6453
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Provider Business Mailing Address
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Address Line | PO BOX 5418
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City | ASHEBORO
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State | NC
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Zip | 27204-5418
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Country | US
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Telephone | 336-625-2333
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ROBERT CLAUSER
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Credential |
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Telephone | 336-625-2333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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