Provider Demographics
NPI:1912599408
Name:ULANGCA, RANDALL (PA-C, PT, DPT)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:ULANGCA
Suffix:
Gender:M
Credentials:PA-C, PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 TREASURY DR APT J
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-6238
Mailing Address - Country:US
Mailing Address - Phone:720-357-5838
Mailing Address - Fax:
Practice Address - Street 1:729 TREASURY DR APT J
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-6238
Practice Address - Country:US
Practice Address - Phone:720-357-5838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-06
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018530225100000X
OH50.008467RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist