Provider Demographics
NPI:1235859125
Name:ITH, RANDY
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:ITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5312 MEADOW GROVE DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8778
Mailing Address - Country:US
Mailing Address - Phone:614-551-9636
Mailing Address - Fax:
Practice Address - Street 1:1 COLLEGE AND MAIN
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-7812
Practice Address - Country:US
Practice Address - Phone:614-236-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer