Provider Demographics
NPI:1174185003
Name:BRIGGS, RANDALL CHARLES (PT)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:CHARLES
Last Name:BRIGGS
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 1:750 E PARK DR FL 2
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2758
Mailing Address - Country:US
Mailing Address - Phone:717-561-8800
Mailing Address - Fax:717-561-5073
Practice Address - Street 1:750 E PARK DR FL 2
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-2758
Practice Address - Country:US
Practice Address - Phone:717-561-8800
Practice Address - Fax:717-561-5073
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006330L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist