Active NPI
Randall L Haratyk, PT
- Physical Therapist
- Corrales, NM
National Provider Identifier
1386658680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2240
- Practice address
- 600 Rincon Rd
Corrales, NM 87048-7651 - Phone
- (505) 899-1509
- Fax
- (505) 890-7380
- NPI assigned
- Jul 29, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 2240 | NM | Primary |
Addresses
Primary practice location
600 Rincon Rd
Corrales, NM 87048-7651
Mailing address
600 Rincon Rd
Corrales, NM 87048-7651
Phone (505) 899-1509
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OOQ464 | Other | NM | BCBS PROVIDER # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2240 | NM | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386658680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 RINCON RD",
"city": "CORRALES",
"state": "NM",
"postal_code": "870487651",
"telephone_number": "505-899-1509",
"fax_number": "505-890-7380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 RINCON RD",
"city": "CORRALES",
"state": "NM",
"postal_code": "870487651",
"telephone_number": "505-899-1509",
"fax_number": "505-890-7380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARATYK",
"first_name": "RANDALL",
"middle_name": "L",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "2240",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER #",
"identifier": "OOQ464",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corrales, NM
Sources for this page
- 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.