Provider Demographics
NPI:1588608764
Name:COHEN, RANDALL PAUL (ATC, PT)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:PAUL
Last Name:COHEN
Suffix:
Gender:M
Credentials:ATC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N110 MCKALE CENTER
Mailing Address - Street 2:UNIVERSITY OF ARIZONA
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0096
Mailing Address - Country:US
Mailing Address - Phone:520-621-4674
Mailing Address - Fax:
Practice Address - Street 1:N110 MCKALE CENTER
Practice Address - Street 2:UNIVERSITY OF ARIZONA
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0001
Practice Address - Country:US
Practice Address - Phone:520-621-4674
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003944A2251S0007X
AZ02742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer