Kirk Christopher Randall, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501005678 Issued in MI

Practice address

3753 Basswood Dr SW
Grandville, MI 49418-2003

Phone

(616) 340-6407

Fax

(616) 301-2882

NPI assigned

Jun 13, 2006

Last updated

Feb 12, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Independence Rehab LLC

  • Physical Therapy Clinic/Center
  • Grandville, MI
  • NPI 1427184589

  Physical Therapist

  NPD (past) Authorized official

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202774400000",
    "number": "1235172826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3753 BASSWOOD DR SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182003",
            "telephone_number": "616-340-6407",
            "fax_number": "616-301-2882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3753 BASSWOOD DR SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182003",
            "telephone_number": "616-340-6407",
            "fax_number": "616-301-2882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "KIRK",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2008-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501005678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7171532",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carly Rose Quinn, DO
• Reyna Becker Rabago, MS
• Ronald Rabineau III, D.C.
• Megan Radaz, OD
• Vijil K Rahulan, MD
• Erica Rangel, LPC
• Julia Raspbury Greenspan, DLLP
• Rauser Counseling LLC
• Stacie Rayman, MSPT
• Kathy Rebh, MA, LPC

• Physical Therapist in Grandville, MI
• Providers in Grandville, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2008; 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.