Provider Demographics
NPI:1184846784
Name:HARMS, RANDALL HENRY (PT)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:HENRY
Last Name:HARMS
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 1:4960 SHADY OAK TR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4468
Mailing Address - Country:US
Mailing Address - Phone:214-735-3603
Mailing Address - Fax:877-871-5352
Practice Address - Street 1:2300 COIT RD #207
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075
Practice Address - Country:US
Practice Address - Phone:214-735-3603
Practice Address - Fax:877-871-5352
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1106565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00525TMedicare ID - Type UnspecifiedSNEAKERS