Provider Demographics
NPI:1326349846
Name:HIL, RANDY (MT)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:
Last Name:HIL
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W 2ND S
Mailing Address - Street 2:
Mailing Address - City:SODA SPRINGS
Mailing Address - State:ID
Mailing Address - Zip Code:83276-5006
Mailing Address - Country:US
Mailing Address - Phone:208-547-4404
Mailing Address - Fax:208-547-3575
Practice Address - Street 1:421 W 2ND S
Practice Address - Street 2:
Practice Address - City:SODA SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83276-5006
Practice Address - Country:US
Practice Address - Phone:208-547-4404
Practice Address - Fax:208-547-3575
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist