Active NPI
Randolph Scott Pallas Jr., DPT
- Physical Therapist
- Wilmington, NC
National Provider Identifier
1407153133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- P13025
- Practice address
- 1705 Gardner Dr
Wilmington, NC 28405-8873 - Phone
- (910) 343-5300
- NPI assigned
- Feb 15, 2011
- Sex
- Male
- Sole proprietor
- No
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 | P13025 | NC | Primary |
Addresses
Primary practice location
1705 Gardner Dr
Wilmington, NC 28405-8873
Mailing address
143 N Palm Dr
Winnabow, NC 28479-5668
Phone (910) 777-8694
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566777600000",
"number": "1407153133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "143 N PALM DR",
"city": "WINNABOW",
"state": "NC",
"postal_code": "284795668",
"telephone_number": "910-777-8694"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1705 GARDNER DR",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284058873",
"telephone_number": "910-343-5300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PALLAS",
"first_name": "RANDOLPH",
"middle_name": "SCOTT",
"name_suffix": "Jr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-02-15",
"last_updated": "2019-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "P13025",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.