Kelly Randell, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

117058 Issued in MO

Practice address

11960 Westline Industrial Dr
Suite 201
Saint Louis, MO 63146-3209

Phone

(314) 819-0480

Fax

(314) 275-7444

NPI assigned

Feb 22, 2015

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 names 1

• Kelly Carter Former name

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.

• Supplemental Health Care

  • Physical Therapy Clinic/Center
  • Saint Louis, MO
  • NPI 1700172400
  NPD (past)
• Supplemental Health Care

  • Adult Care Home Facility
  • Saint Louis, MO
  • NPI 1902129653
  NPD (past)

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

{
    "created_epoch": "1424563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424563200000",
    "number": "1376935791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11960 WESTLINE INDUSTRIAL DR",
            "address_2": "SUITE 201",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631463209",
            "telephone_number": "314-819-0480",
            "fax_number": "314-275-7444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11960 WESTLINE INDUSTRIAL DR",
            "address_2": "SUITE 201",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631463209",
            "telephone_number": "314-819-0480",
            "fax_number": "314-275-7444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDELL",
        "first_name": "KELLY",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-22",
        "last_updated": "2015-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "117058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "CARTER",
            "credential": "PTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Camille Randall, PHD
• James William Randall, MD
• Michelle Patrice Randall
• Nicholas Randall
• Elena Cristina Randazzo, MD
• Lovepreet Singh Randhawa, MD
• Saboor Ejaz Randhawa, MBBS
• Sandeep Randhawa, M.D.
• Dionne Randle
• Laconte Randle, NURSE PRACTITIONER

• Physical Therapy Assistant in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2015; 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.