Provider Demographics
NPI:1255450623
Name:RANDOLPH, JAMES A (PT, DPT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:RANDOLPH
Suffix:
Gender:
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 1:1001 COMMERCE DR STE 600
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8914
Mailing Address - Country:US
Mailing Address - Phone:630-933-1500
Mailing Address - Fax:331-732-4581
Practice Address - Street 1:1001 COMMERCE DR STE 600
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-8914
Practice Address - Country:US
Practice Address - Phone:630-933-1500
Practice Address - Fax:331-732-4581
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9870225100000X
IL070012723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216859041Medicare PIN
ILP00844089OtherMEDICARE RR
IL202845076Medicare PIN