Provider Demographics
NPI:1376913632
Name:HASIK, RANDY MICHELE (DPT, CLT-LANA)
Entity Type:Individual
Prefix:MRS
First Name:RANDY
Middle Name:MICHELE
Last Name:HASIK
Suffix:
Gender:F
Credentials:DPT, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5849
Mailing Address - Country:US
Mailing Address - Phone:817-498-3919
Mailing Address - Fax:817-498-7080
Practice Address - Street 1:1109 CHURCH ST
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5849
Practice Address - Country:US
Practice Address - Phone:817-498-3919
Practice Address - Fax:817-498-7080
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1167538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1167538OtherPHYSICAL THEARPY LICENSE