Provider Demographics
NPI:1598749376
Name:ALDRIDGE, RANDAL JAY (MS PT ATC)
Entity Type:Individual
Prefix:MR
First Name:RANDAL
Middle Name:JAY
Last Name:ALDRIDGE
Suffix:
Gender:M
Credentials:MS PT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2110
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36831-2110
Mailing Address - Country:US
Mailing Address - Phone:334-707-7848
Mailing Address - Fax:
Practice Address - Street 1:2272 MOORES MILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-8444
Practice Address - Country:US
Practice Address - Phone:334-707-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5136225100000X
ALPTH 18202251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q33973Medicare UPIN