Provider Demographics
NPI:1598302143
Name:SAMPERE, RANDA RENEE (PT)
Entity Type:Individual
Prefix:
First Name:RANDA
Middle Name:RENEE
Last Name:SAMPERE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5026 DEEPWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-2901
Mailing Address - Country:US
Mailing Address - Phone:361-334-2317
Mailing Address - Fax:361-334-2466
Practice Address - Street 1:5026 DEEPWOOD CIR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-2901
Practice Address - Country:US
Practice Address - Phone:361-334-2317
Practice Address - Fax:361-334-2466
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11668R225100000X
TX1270946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist