Provider Demographics
NPI:1720076516
Name:TOTH, RANDY J (PT, LAT, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:J
Last Name:TOTH
Suffix:
Gender:M
Credentials:PT, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20805 SHAMROCK GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3976
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20500 SENECA MEADOWS PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-7008
Practice Address - Country:US
Practice Address - Phone:301-916-8500
Practice Address - Fax:301-528-6258
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MD242202251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer