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NPI Code Detail

MEDICARE: CARRIE A. RANDELL P.T.

MEDICARE: CARRIE A. RANDELL P.T.
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 Therapist070-008500IL

General Provider Information

NPI Number : 1942220819
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARRIE A. RANDELL P.T.
Provider Business Mailing Address
First Line : 530 NE GLEN OAK AVE
Second Line :
City : PEORIA
State : IL
Zip : 61637-0001
Country : US
Telephone Number : 309-655-2000
Fax Number : 309-655-7869
Provider Business Practice Location Address
First Line : 100 NE RANDOLPH AVE
Second Line :
City : PEORIA
State : IL
Zip : 61606-1919
Country : US
Telephone Number : 309-624-8575
Fax Number : 309-624-8566
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 09/19/2019

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Directions to “ CARRIE A. RANDELL P.T.” Practice Location

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