Provider Demographics
NPI:1073101952
Name:RANDOLPH, PAMELA LEA (PT, DPT, MBA)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LEA
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:PT, DPT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 RANDOLPH DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-4312
Mailing Address - Country:US
Mailing Address - Phone:970-390-5916
Mailing Address - Fax:
Practice Address - Street 1:1038 RANDOLPH DR
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-4312
Practice Address - Country:US
Practice Address - Phone:970-390-5916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
PAPT028537225100000X
NJQA01133200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist