MEDICARE: RANDI BAGLEY

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	225200000X	Physical Therapy Assistant	0646	NH

General Provider Information

NPI Number	:	1497062020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDI BAGLEY

Provider Business Mailing Address
First Line	:	3855 DARTMOUTH COLLEGE HWY
Second Line	:
City	:	N HAVERHILL
State	:	NH
Zip	:	03774-4937
Country	:	US
Telephone Number	:	603-546-7416
Fax Number	:

Provider Business Practice Location Address
First Line	:	3855 DARTMOUTH COLLEGE HWY
Second Line	:
City	:	N HAVERHILL
State	:	NH
Zip	:	03774-4937
Country	:	US
Telephone Number	:	603-546-7416
Fax Number	:

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

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	09/02/2010

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Directions to “ RANDI BAGLEY ” Practice Location

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