Provider Demographics
NPI:1790228922
Name:VOLLERTSEN, RANDA (MA, PT)
Entity Type:Individual
Prefix:
First Name:RANDA
Middle Name:
Last Name:VOLLERTSEN
Suffix:
Gender:F
Credentials:MA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:KS
Mailing Address - Zip Code:67654-2046
Mailing Address - Country:US
Mailing Address - Phone:785-871-0100
Mailing Address - Fax:
Practice Address - Street 1:113 N STATE ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:KS
Practice Address - Zip Code:67654-2046
Practice Address - Country:US
Practice Address - Phone:785-871-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-20
Last Update Date:2016-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-000568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist