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General NPI Number Information
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NPI Number | 1649482613
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Entity Type | Individual
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Provider Name | RANDI MITCHELL INCARDONA PT
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3943 CLARK RD
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City | SARASOTA
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State | FL
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Zip | 34233-2364
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Country | US
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Telephone | 941-926-3363
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Fax | 941-926-3342
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Provider Business Mailing Address
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Address Line | PO BOX 19227
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City | SARASOTA
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State | FL
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Zip | 34276-2227
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Country | US
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Telephone | 941-926-3363
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Fax | 941-926-3342
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | PT00004610
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License Number State | FL
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