Active NPI
Jennifer Randall
- Physical Therapist
- Eugene, OR
National Provider Identifier
1104291160
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10748
- Practice address
- 488 E 11TH Ave Ste 150a
Eugene, OR 97401-3601 - Phone
- (541) 505-7134
- NPI assigned
- Dec 2, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 039567 | NY | |
| Physical Therapist | 225100000X | 10748 | CT | Primary |
Addresses
Primary practice location
488 E 11TH Ave Ste 150a
Eugene, OR 97401-3601
Mailing address
5300 Dutch Hill Rd
Cincinnatus, NY 13040-2106
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10748 | CT | MD | Physical Therapist |
| 039567 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1449014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449014400000",
"number": "1104291160",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5300 DUTCH HILL RD",
"city": "CINCINNATUS",
"state": "NY",
"postal_code": "130402106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "488 E 11TH AVE STE 150A",
"city": "EUGENE",
"state": "OR",
"postal_code": "974013601",
"telephone_number": "541-505-7134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-12-02",
"last_updated": "2015-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "039567",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "10748",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.