Provider Demographics
NPI:1841539988
Name:RICHARDSON, RANDI MOAK (DPT, SCS)
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:MOAK
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DPT, SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 MILES CT
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-3456
Mailing Address - Country:US
Mailing Address - Phone:601-730-2137
Mailing Address - Fax:
Practice Address - Street 1:4098 LIBRA DR RM 114
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32816-7123
Practice Address - Country:US
Practice Address - Phone:407-823-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-09
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT266292251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHE278ZMedicare PIN