Provider Demographics
NPI:1639184096
Name:CHRISTOPHERSON, RANDALL CARTER (PT)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:CARTER
Last Name:CHRISTOPHERSON
Suffix:
Gender:M
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:PO BOX 301
Mailing Address - Street 2:109 S. MAIN ST. SUITE D
Mailing Address - City:LYMAN
Mailing Address - State:WY
Mailing Address - Zip Code:82937-0301
Mailing Address - Country:US
Mailing Address - Phone:307-747-4627
Mailing Address - Fax:307-787-6212
Practice Address - Street 1:109 SOUTH MAIN ST.
Practice Address - Street 2:SUITE D
Practice Address - City:LYMAN
Practice Address - State:WY
Practice Address - Zip Code:82937
Practice Address - Country:US
Practice Address - Phone:307-747-4627
Practice Address - Fax:307-787-6212
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-0359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist