Jeremiah Thomas Randall, PT

Primary specialty

Sports Physical TherapistTaxonomy code 2251S0007X

License

11-04026 Issued in KS

Practice address

1336 N Walnut St
Iola, KS 66749-1601

Phone

(620) 365-6989

NPI assigned

Nov 21, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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 and National Provider Directory roles.

• Salt Creek Rehab LLC

  • Physical Therapy Assistant
  • Osage City, KS
  • NPI 1235243460

  Sports

  NPD (past)

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

{
    "created_epoch": "1258761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258761600000",
    "number": "1366770828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10684 W 825 RD",
            "city": "MOUND CITY",
            "state": "KS",
            "postal_code": "660569112",
            "telephone_number": "913-645-0264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1336 N WALNUT ST",
            "city": "IOLA",
            "state": "KS",
            "postal_code": "667491601",
            "telephone_number": "620-365-6989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "JEREMIAH",
        "middle_name": "THOMAS",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-21",
        "last_updated": "2009-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "KS",
            "license": "11-04026",
            "primary": true
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "FL",
            "license": "24988",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Stephen Oakson, DDS
• Carly Obrien, PHARMD
• Frank O Porter, DO
• Preferred Medical Associates
• Preferred Medical Associates
• Jeffrey B Ready, LCP
• Ryan Regehr
• Rehabvisions
• Jarrod L Reichelt, M.A
• Rachel Reis Da Silva

• Sports Physical Therapist in Iola, KS
• Providers in Iola, KS by specialty
• Sports Physical Therapist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2009; 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.