Provider Demographics
NPI:1659483899
Name:DENTON, RANDAL N (PT, OCS, DPT)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:N
Last Name:DENTON
Suffix:
Gender:M
Credentials:PT, OCS, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5454 SURREY PATH STE 103
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9581
Mailing Address - Country:US
Mailing Address - Phone:214-618-2424
Mailing Address - Fax:214-618-2432
Practice Address - Street 1:5454 SURREY PATH STE 103
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9581
Practice Address - Country:US
Practice Address - Phone:214-618-2424
Practice Address - Fax:214-618-2432
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1114601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX471157ZS1MMedicare PIN
TX470447Medicare PIN