Provider Demographics
NPI:1841425758
Name:DAILEY, RANDY ALAN (PT)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:ALAN
Last Name:DAILEY
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 1416
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-1416
Mailing Address - Country:US
Mailing Address - Phone:276-694-0124
Mailing Address - Fax:276-694-0125
Practice Address - Street 1:227 LANDMARK DRIVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171
Practice Address - Country:US
Practice Address - Phone:276-694-0124
Practice Address - Fax:276-694-0125
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist