Provider Demographics
NPI:1023746351
Name:RANDOLPH, NICOLE CELINE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CELINE
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 S VICTOR AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-2613
Mailing Address - Country:US
Mailing Address - Phone:918-729-2569
Mailing Address - Fax:
Practice Address - Street 1:8988 S SHERIDAN RD STE Y
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5035
Practice Address - Country:US
Practice Address - Phone:918-265-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist