Provider Demographics
NPI:1093872426
Name:PACATTE, RANDALL (PT)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:PACATTE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 STATE ROUTE 7
Mailing Address - Street 2:STORE #5
Mailing Address - City:COBLESKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12043-5740
Mailing Address - Country:US
Mailing Address - Phone:518-234-7760
Mailing Address - Fax:
Practice Address - Street 1:2403 STATE ROUTE 7
Practice Address - Street 2:STORE #5
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-5740
Practice Address - Country:US
Practice Address - Phone:518-234-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011676225100000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare UPIN
NYPENDINGMedicare ID - Type Unspecified