Provider Demographics
NPI:1962489807
Name:CADMAN, RANDY D (PT)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:D
Last Name:CADMAN
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 1:17610 SW ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97003-4411
Mailing Address - Country:US
Mailing Address - Phone:503-642-4555
Mailing Address - Fax:503-591-9877
Practice Address - Street 1:17610 SW ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97003-4411
Practice Address - Country:US
Practice Address - Phone:503-642-4555
Practice Address - Fax:503-591-9877
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR262956Medicaid
OR262956Medicaid