Active NPI
Anne Willy Randall, BS
- Pediatric Physical Therapist
- San Diego, CA
National Provider Identifier
1083746705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 10222
- Practice address
- 6160 Mission Gorge Rd
Suite 400
San Diego, CA 92120-3410 - Phone
- (619) 528-4000
- NPI assigned
- Mar 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 10222 | CA | Primary |
Addresses
Primary practice location
6160 Mission Gorge Rd
Suite 400
San Diego, CA 92120-3410
Mailing address
5625 Aztec Dr
La Mesa, CA 91942-1947
Phone (619) 460-2562
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10222 | CA | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083746705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5625 AZTEC DR",
"city": "LA MESA",
"state": "CA",
"postal_code": "919421947",
"telephone_number": "619-460-2562"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6160 MISSION GORGE RD",
"address_2": "SUITE 400",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921203410",
"telephone_number": "619-528-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "ANNE",
"middle_name": "WILLY",
"name_prefix": "Mrs.",
"credential": "BS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "CA",
"license": "10222",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.