Provider Demographics
NPI:1518901891
Name:HARTZELL, RANDALL W (PT)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:W
Last Name:HARTZELL
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 1:916 SW 38TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-7005
Mailing Address - Country:US
Mailing Address - Phone:580-353-1490
Mailing Address - Fax:580-250-1651
Practice Address - Street 1:916 SW 38TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-7005
Practice Address - Country:US
Practice Address - Phone:580-353-1490
Practice Address - Fax:580-250-1651
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist