Individual provider Active NPI

Randall C Pulsipher, P.T

  • Physical Therapist
  • Mesa, AZ
National Provider Identifier
1366779910
Registry record updated Jun 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4310 Issued in AZ
Practice address
6938 E Milagro Ave
Mesa, AZ 85209-6653
Phone
(480) 228-1547
NPI assigned
Nov 3, 2009
Last updated
Jun 14, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 14, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 4310 AZ Primary

Addresses

Primary practice location

6938 E Milagro Ave
Mesa, AZ 85209-6653

Mailing address

6938 E Milagro Ave
Mesa, AZ 85209-6653
Phone (480) 228-1547

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091218000185 AZ Practitioner - Physical Therapist in Private Practice 9931249182 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4310AZMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anderson & Bates Inc Physical Therapist CurrentSince Nov 1, 2009 Accepting new patients
Arizona Mobile Therapy LLC Physical Therapist CurrentSince Aug 23, 2023 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1257206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528934400000",
    "number": "1366779910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6938 E MILAGRO AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852096653",
            "telephone_number": "480-228-1547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6938 E MILAGRO AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852096653",
            "telephone_number": "480-228-1547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULSIPHER",
        "first_name": "RANDALL",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "credential": "P.T",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-11-03",
        "last_updated": "2018-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "4310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2018; 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.

Verify at the official NPI Registry.