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General NPI Number Information
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NPI Number | 1629006473
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Entity Type | Individual
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Provider Name | JULIE C RANDALL PT
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Gender | Female
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 04/18/2014
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Provider Practice Location Address
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Address Line | 6319 FLY RD SUITE 3
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9357
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Country | US
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Telephone | 315-410-6200
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Fax | 315-451-2095
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Provider Business Mailing Address
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Address Line | 7455 MORGAN RD SUITE 2
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City | LIVERPOOL
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State | NY
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Zip | 13090-3956
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Country | US
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Telephone | 315-451-6767
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Fax | 315-451-0569
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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 | 020542-1
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License Number State | NY
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