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General NPI Number Information
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NPI Number | 1831370089
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Entity Type | Individual
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Provider Name | RANDALL CHARLES DEAN RPT
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Gender | Female
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 16322 OFFENHAUR RD
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City | ODESSA
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State | FL
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Zip | 33556-2328
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Country | US
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Telephone | 727-458-3667
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Fax | 813-920-8596
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Provider Business Mailing Address
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Address Line | 16322 OFFENHAUR RD
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City | ODESSA
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State | FL
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Zip | 33556-2328
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Country | US
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Telephone | 727-458-3667
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Fax | 813-920-8596
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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 | 7375
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License Number State | FL
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