Active NPI
Randy James Mack, MPT
- Physical Therapist
- Madera, CA
National Provider Identifier
1265142368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 22133
- Practice address
- 9300 Valley Childrens PL
Madera, CA 93636-8762 - Phone
- (559) 353-6130
- NPI assigned
- Nov 29, 2022
- Last updated
- Nov 29, 2022
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 22133 | CA | Primary |
Addresses
Primary practice location
9300 Valley Childrens PL
Madera, CA 93636-8762
Mailing address
9300 Valley Childrens PL
Madera, CA 93636-8762
Phone (559) 353-6130
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22133 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669680000000",
"number": "1265142368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9300 VALLEY CHILDRENS PL",
"city": "MADERA",
"state": "CA",
"postal_code": "936368762",
"telephone_number": "559-353-6130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9300 VALLEY CHILDRENS PL",
"city": "MADERA",
"state": "CA",
"postal_code": "936368762",
"telephone_number": "559-353-6130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "RANDY",
"middle_name": "JAMES",
"name_prefix": "Mr.",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-11-29",
"last_updated": "2022-11-29",
"certification_date": "2022-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "22133",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madera, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.