Provider Demographics
NPI:1598118317
Name:VEREB, RANDALL ARMSTRONG (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:ARMSTRONG
Last Name:VEREB
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:RANDALL
Other - Middle Name:ARMSTRONG
Other - Last Name:WILKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:PO BOX 14485
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32604-2485
Mailing Address - Country:US
Mailing Address - Phone:352-375-4683
Mailing Address - Fax:352-375-8432
Practice Address - Street 1:121 GALE LEMERAND DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-2051
Practice Address - Country:US
Practice Address - Phone:352-375-4683
Practice Address - Fax:352-375-8432
Is Sole Proprietor?:No
Enumeration Date:2016-07-16
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL25632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer