Provider Demographics
NPI:1831370089
Name:DEAN, RANDALL CHARLES (RPT)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:CHARLES
Last Name:DEAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16322 OFFENHAUR RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2328
Mailing Address - Country:US
Mailing Address - Phone:727-458-3667
Mailing Address - Fax:813-920-8596
Practice Address - Street 1:16322 OFFENHAUR RD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-2328
Practice Address - Country:US
Practice Address - Phone:727-458-3667
Practice Address - Fax:813-920-8596
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist