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NPI Code Detail

MEDICARE: CATHERINE RANDALL FANDEL DPT

MEDICARE: CATHERINE RANDALL FANDEL DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT 5604MS

General Provider Information

NPI Number : 1184010985
Entity Type Code : Individual
Provider Name (Legal Business Name) : CATHERINE RANDALL FANDEL DPT
Provider Business Mailing Address
First Line : 430 HUNTINGTON CT
Second Line :
City : NEW ALBANY
State : MS
Zip : 38652-1912
Country : US
Telephone Number : 662-207-1053
Fax Number :
Provider Business Practice Location Address
First Line : 1411 HIGHWAY 389
Second Line :
City : STARKVILLE
State : MS
Zip : 39759-8451
Country : US
Telephone Number : 662-769-4888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2015
Last Update Date : 04/09/2015

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