Provider Demographics
NPI:1134676018
Name:WHITT, RANDALL JASON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:JASON
Last Name:WHITT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROBERTSON DR
Mailing Address - Street 2:SUITE 20
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-1716
Mailing Address - Country:US
Mailing Address - Phone:908-719-2000
Mailing Address - Fax:908-719-9778
Practice Address - Street 1:1 ROBERTSON DR
Practice Address - Street 2:SUITE 20
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-1716
Practice Address - Country:US
Practice Address - Phone:908-719-2000
Practice Address - Fax:908-719-9778
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01686000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist