Provider Demographics
NPI:1629006473
Name:RANDALL, JULIE C (PT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:RANDALL
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:7455 MORGAN RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-3956
Mailing Address - Country:US
Mailing Address - Phone:315-451-6767
Mailing Address - Fax:315-451-0569
Practice Address - Street 1:6319 FLY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9357
Practice Address - Country:US
Practice Address - Phone:315-410-6200
Practice Address - Fax:315-451-2095
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY020542-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161303109OtherCIGNA
NY000131712OtherBSCNY
NY000921584005OtherHEALTHNOW NY
NYAA1220Medicare PIN
NY000921584005OtherHEALTHNOW NY