MEDICARE: MR. RANDY EDWARD YOCUM DPT, CSCS

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
1	225100000X	Physical Therapist	PT008224L	PA
2	225100000X	Physical Therapist	P22440	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P22440	OTHER	NC	PT LICENSE

General Provider Information

NPI Number	:	1295733251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RANDY EDWARD YOCUM DPT, CSCS

Provider Business Mailing Address
First Line	:	PO BOX 5105
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-5100
Country	:	US
Telephone Number	:	919-220-5255
Fax Number	:	919-220-6971

Provider Business Practice Location Address
First Line	:	7608 PURFOY RD
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-8930
Country	:	US
Telephone Number	:	919-220-5255
Fax Number	:

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	09/26/2024

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