Provider Demographics
NPI:1679791461
Name:DOOLITTLE, RANDY JAY (PT)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:JAY
Last Name:DOOLITTLE
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 1:18503 BENT PINE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-5719
Mailing Address - Country:US
Mailing Address - Phone:352-597-8996
Mailing Address - Fax:352-597-2809
Practice Address - Street 1:6226 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34613-6325
Practice Address - Country:US
Practice Address - Phone:352-597-8996
Practice Address - Fax:352-597-2809
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist