Provider Demographics
NPI:1841537024
Name:RANDALL, MARCUM RALPH (LP, LPT)
Entity type:Individual
Prefix:
First Name:MARCUM
Middle Name:RALPH
Last Name:RANDALL
Suffix:
Gender:M
Credentials:LP, LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7051 CYPRESS TER STE 108
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-8801
Mailing Address - Country:US
Mailing Address - Phone:239-437-4010
Mailing Address - Fax:
Practice Address - Street 1:7051 CYPRESS TER STE 108
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-8801
Practice Address - Country:US
Practice Address - Phone:239-437-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT42722251H1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHuman Factors
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6695430001OtherMEDICARE