Provider Demographics
NPI:1750818506
Name:EADS, RANDALL LEE (PT, DPT, OCS, CSCS)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:LEE
Last Name:EADS
Suffix:
Gender:
Credentials:PT, DPT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 DRIVE IN LN
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3154
Mailing Address - Country:US
Mailing Address - Phone:843-989-0199
Mailing Address - Fax:
Practice Address - Street 1:441 DRIVE IN LN
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3154
Practice Address - Country:US
Practice Address - Phone:843-989-0199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist