Conny Christl Randolph, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT1635 Issued in MS

Practice address

808 Hwy 98 Bypass
Columbia, MS 39429-0429

Phone

(601) 731-1140

Fax

(601) 731-1148

NPI assigned

Oct 3, 2006

Sex

Female

Sole proprietor

No

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)

Not 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 and National Provider Directory roles.

• Scott'S Family Fitness & Physical Therapy

  • Physical Therapist
  • Columbia, MS
  • NPI 1326133455
  NPD (past) Authorized official

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306930979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "571 PICKWICK ROAD",
            "city": "FOXWORTH",
            "state": "MS",
            "postal_code": "39483",
            "telephone_number": "601-736-6617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 HWY 98 BYPASS",
            "city": "COLUMBIA",
            "state": "MS",
            "postal_code": "394290429",
            "telephone_number": "601-731-1140",
            "fax_number": "601-731-1148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "CONNY",
        "middle_name": "CHRISTL",
        "name_prefix": "Mrs.",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT1635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00121739",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Ross Priddy, FNP
• Psychiatric Services of Columbia
• Pure Touch Home Care, LLC
• Quality Care Internal Medicine of North America
• Quality Medical Clinic, Inc.
• Destiny Rawls
• Gerald Devoe Reed
• Iman A Reed
• Reflections Vision Center Columbia, LLC
• Taytum Mackenzie Reid, DPT

• Physical Therapist in Columbia, MS
• Providers in Columbia, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.