Provider Demographics
NPI:1477543718
Name:RANDOLPH, BILLIE JANE (PT)
Entity Type:Individual
Prefix:DR
First Name:BILLIE
Middle Name:JANE
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BILLIE
Other - Middle Name:JANE
Other - Last Name:MIELCAREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6394 TRUE LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1030
Mailing Address - Country:US
Mailing Address - Phone:703-971-5769
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0004
Practice Address - Country:US
Practice Address - Phone:301-295-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052049692251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305204969OtherSTATE LICENSURE BOARD
KY000736OtherSTATE LICENSE