Provider Demographics
NPI:1841234572
Name:WESTFALL, RANDY (PT, MTC)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:
Last Name:WESTFALL
Suffix:
Gender:M
Credentials:PT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S ARROWHEAD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6984
Mailing Address - Country:US
Mailing Address - Phone:816-795-6999
Mailing Address - Fax:816-795-3366
Practice Address - Street 1:4900 S ARROWHEAD DR
Practice Address - Street 2:SUITE B
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6984
Practice Address - Country:US
Practice Address - Phone:816-795-6999
Practice Address - Fax:816-795-3366
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266520Medicare ID - Type UnspecifiedPROVIDER NUMBER