Provider Demographics
NPI:1952855090
Name:POPE, RANDEE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RANDEE
Middle Name:
Last Name:POPE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4935 RUE VALLEE
Mailing Address - Street 2:APT 64
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6658
Mailing Address - Country:US
Mailing Address - Phone:517-402-8495
Mailing Address - Fax:
Practice Address - Street 1:3960 PATIENT CARE DR STE 117
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4279
Practice Address - Country:US
Practice Address - Phone:517-325-0996
Practice Address - Fax:517-882-8940
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012201A225100000X
MI5501019174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05012201AOtherPHYSICAL THERAPY LICENSE NUMBER