Randa and Wahl, a Physical Therapy Corp.

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT 28176 Issued in CA

Legal business name

RANDA AND WAHL, A PHYSICAL THERAPY CORP.

Doing business as

Back on Track

Practice address

1815 E Main St
Barstow, CA 92311-3234

Phone

(760) 256-2800

Fax

(760) 256-2809

NPI assigned

Nov 1, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacqueline Randa, PT, OCS

Title

President

Phone

(760) 256-2800

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Back on Track Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michele Wahl, PT

  • Physical Therapist
  • Apple Valley, CA
  • NPI 1679683676
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194802306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 E MAIN ST",
            "city": "BARSTOW",
            "state": "CA",
            "postal_code": "923113234",
            "telephone_number": "760-256-2800",
            "fax_number": "760-256-2809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 E MAIN ST",
            "city": "BARSTOW",
            "state": "CA",
            "postal_code": "923113234",
            "telephone_number": "760-256-2800",
            "fax_number": "760-256-2809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDA AND WAHL, A PHYSICAL THERAPY CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RANDA",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-256-2800",
        "authorized_official_credential": "PT, OCS"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "PT 25062",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "PT 28176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP ID",
            "identifier": "ZZZ07464Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Back on Track",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ruth Ramirez-Meza
• Ashley Ramirez
• Celeste Ramirez
• Cynthia Ramirez
• Maria Victoria Ramirez
• Carla Antoinette Randolph
• Lydia Dolores Rasmussen, NURSE PRACTITIONER
• Cortney Rasplicka, MA, PPS
• Ravindra Gautam, M.D., Inc.
• Ravindra Gautam, M.D., Inc. (Ravindra Gautam MD)

• Physical Therapy Clinic/Center in Barstow, CA
• Providers in Barstow, CA by specialty
• Physical Therapy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.