Kelly Gene Randolph, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-1256 Issued in WY

Practice address

1726 Beck Ave
Cody, WY 82414-3925

Phone

(307) 587-9866

Fax

(307) 587-9867

NPI assigned

Sep 30, 2008

Last updated

Sep 30, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advantage Rehab

  • Physical Therapist
  • Cody, WY
  • NPI 1851419832
  NPD (past)
• Canyon Hand Therapy, P.C.

  dba Canyon Therapy

  • Physical Therapy Clinic/Center
  • Cody, WY
  • NPI 1639476443
  NPD (past)

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222732800000",
    "number": "1447401104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1726 BECK AVE",
            "city": "CODY",
            "state": "WY",
            "postal_code": "824143925",
            "telephone_number": "307-587-9866",
            "fax_number": "307-587-9867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1726 BECK AVE",
            "city": "CODY",
            "state": "WY",
            "postal_code": "824143925",
            "telephone_number": "307-587-9866",
            "fax_number": "307-587-9867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "KELLY",
        "middle_name": "GENE",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-30",
        "last_updated": "2008-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WY",
            "license": "PT-1256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Elizabeth Powell
• Molly Quaranto, PA-C
• Zachary Monroe Quintanar
• Herbert Rakestraw
• Lori Ramseier, RPH
• Courtney Leigh Rasely
• Robert A Raver
• Karry Nelly Rayment
• Leah Renaud
• Alexander Rettinghouse

• Physical Therapist in Cody, WY
• Providers in Cody, WY by specialty
• Physical Therapist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2008; 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.