MEDICARE: ANTIONETTE RANDALL LPN, PT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3416L0300X	Land Ambulance
3	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1235081654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTIONETTE RANDALL LPN, PT

Provider Business Mailing Address
First Line	:	110 OLD SILO RD
Second Line	:
City	:	RAYNE
State	:	LA
Zip	:	70578-2550
Country	:	US
Telephone Number	:	337-909-9524
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 ONTARIO AVE
Second Line	:
City	:	DUSON
State	:	LA
Zip	:	70529
Country	:	US
Telephone Number	:	337-909-5241
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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