Active NPI
Randy Dale Couch, P.T.
- Physical Therapist
- Antioch, CA
National Provider Identifier
1275605255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT13486
- Practice address
- 4041 Lone Tree Way # 106
Antioch, CA 94531-6200 - Phone
- (925) 754-6262
- Fax
- (925) 754-2198
- NPI assigned
- Nov 14, 2006
- 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 | PT13486 | CA | Primary |
Addresses
Primary practice location
4041 Lone Tree Way # 106
Antioch, CA 94531-6200
Mailing address
4041 Lone Tree Way # 106
Antioch, CA 94531-6200
Phone (925) 754-6262
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081212000660 | CA | Practitioner - Physical Therapist in Private Practice | 9335200062 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT13486 | CA | MD | Physical Therapist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- Antioch, CA
- NPI 1689181778
CA
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194912000000",
"number": "1275605255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4041 LONE TREE WAY # 106",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945316200",
"telephone_number": "925-754-6262",
"fax_number": "925-754-2198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4041 LONE TREE WAY # 106",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945316200",
"telephone_number": "925-754-6262",
"fax_number": "925-754-2198"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COUCH",
"first_name": "RANDY",
"middle_name": "DALE",
"name_prefix": "Mr.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-14",
"last_updated": "2007-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT13486",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Antioch, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.