Provider Demographics
NPI:1053640508
Name:BRANDT, RANDI LEIGH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:LEIGH
Last Name:BRANDT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W COMANCHE
Mailing Address - Street 2:
Mailing Address - City:CASHION
Mailing Address - State:OK
Mailing Address - Zip Code:73016
Mailing Address - Country:US
Mailing Address - Phone:405-433-2601
Mailing Address - Fax:
Practice Address - Street 1:206 W COMANCHE
Practice Address - Street 2:
Practice Address - City:CASHION
Practice Address - State:OK
Practice Address - Zip Code:73016
Practice Address - Country:US
Practice Address - Phone:405-433-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1399225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant