Provider Demographics
NPI:1598704983
Name:FORSYTH, RANDY JOE (PT)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:JOE
Last Name:FORSYTH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1335 NORTHFIELD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-9390
Mailing Address - Country:US
Mailing Address - Phone:435-865-1902
Mailing Address - Fax:435-586-5176
Practice Address - Street 1:1335 NORTHFIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-9390
Practice Address - Country:US
Practice Address - Phone:435-865-1902
Practice Address - Fax:435-586-5176
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT121023-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT638842OtherDMBA
UT650019321OtherRAILROAD MEDICARE
UT9212023202001OtherBCBS PPO
UT6480151OtherUNITED HEALTH CARE
UT0174004OtherWASHINGTON STATE LABOR
UT5088449OtherAETNA
UT59792OtherPEHP
UTPRA03874OtherMOLINA
UT870656237RF2OtherEDUCATORS MUTUAL
UT9212102320001OtherBCBS TRADITIONAL
UT107007215101OtherSELECT HEALTH
UT876542OtherARIZONA PHYSICIANS HEALTH
UT034181OtherSELECT MED
UT870656237RF2OtherEDUCATORS MUTUAL
UTP09965Medicare UPIN