Individual provider Active NPI

Mary Kathleen Randall

  • Physical Therapist
  • Greensboro, NC
National Provider Identifier
1457028920
Registry record updated Nov 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
P23461 Issued in NC
Practice address
4112 Spring Garden St
Greensboro, NC 27407-1684
Phone
(336) 294-0910
NPI assigned
Aug 24, 2021
Last updated
Nov 26, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 26, 2025

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 P23461 NC Primary

Addresses

Primary practice location

4112 Spring Garden St
Greensboro, NC 27407-1684

Mailing address

4112 Spring Garden St
Greensboro, NC 27407-1684
Phone (336) 294-0910

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241202002551 NC Practitioner - Physical Medicine and Rehabilitation 7012442908 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrative Therapies IncGroup PAC ID 0143659037, 2 clinicians

Practice addresses (Care Compare)

4112 Spring Garden St
Suite a
Greensboro, NC 27407-1652
Phone (336) 294-0910

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P23461NCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Integrative Therapies, Inc. Physical Therapist CurrentSince Sep 7, 2024 Accepting new patients
Florida Fitness and Rehabilitation, Inc. Physical Therapist PastSince Aug 1, 2021 Accepting new patients
Fyzbiz, LLC Physical Therapist PastSince Aug 1, 2021 Accepting new patients

Locations

4112 Spring Garden St
Ste A
Greensboro, NC 27407
Phone (336) 294-0910

Networks

  • Freedom Health HMO Network

Organizations & group practices 3

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": "1629763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764115200000",
    "number": "1457028920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4112 SPRING GARDEN ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274071684",
            "telephone_number": "336-294-0910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4112 SPRING GARDEN ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274071684",
            "telephone_number": "336-294-0910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "MARY",
        "middle_name": "KATHLEEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-24",
        "last_updated": "2025-11-26",
        "certification_date": "2025-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P23461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

Verify at the official NPI Registry.