Provider Demographics
NPI:1982909487
Name:DEMERS, RANDY SUSAN (LICENSED PHYSICAL TH)
Entity Type:Individual
Prefix:MRS
First Name:RANDY
Middle Name:SUSAN
Last Name:DEMERS
Suffix:
Gender:F
Credentials:LICENSED PHYSICAL TH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 BUDDS CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:20622
Mailing Address - Country:US
Mailing Address - Phone:301-290-0800
Mailing Address - Fax:301-290-1313
Practice Address - Street 1:29770 THREE NOTCH ROAD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622
Practice Address - Country:US
Practice Address - Phone:301-290-0800
Practice Address - Fax:301-290-1313
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist