Provider Demographics
NPI:1891949012
Name:HUNTER, RANDI L (ATC, PTA)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:L
Last Name:HUNTER
Suffix:
Gender:F
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:L
Other - Last Name:MEHMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32 E MAIN ST
Mailing Address - Street 2:PO BOX 474
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4903
Mailing Address - Country:US
Mailing Address - Phone:641-753-6636
Mailing Address - Fax:641-753-1005
Practice Address - Street 1:32 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4903
Practice Address - Country:US
Practice Address - Phone:641-753-6636
Practice Address - Fax:641-753-1005
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004986225200000X
IA005732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer