Provider Demographics
NPI:1033858337
Name:KASS, RANDI V (DPT)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:V
Last Name:KASS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 BEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3908
Mailing Address - Country:US
Mailing Address - Phone:515-255-3932
Mailing Address - Fax:515-462-0281
Practice Address - Street 1:1300 50TH ST STE 102
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5499
Practice Address - Country:US
Practice Address - Phone:515-882-0800
Practice Address - Fax:515-462-0281
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA114150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty