Provider Demographics
NPI:1932518438
Name:RANDALL, ANNA L (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:L
Last Name:RANDALL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 SKYLYN DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1032
Mailing Address - Country:US
Mailing Address - Phone:864-342-0180
Mailing Address - Fax:864-342-0183
Practice Address - Street 1:1420 SKYLYN DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1032
Practice Address - Country:US
Practice Address - Phone:864-342-0180
Practice Address - Fax:864-342-0183
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist