Active NPI
Andrew Randall, DPT
- Physical Therapist
- Fargo, ND
National Provider Identifier
1497278667
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2226
- Practice address
- Sanford Broadway Medical Building 736 Broadway N
Fargo, ND 58122-4001 - Phone
- (701) 234-6735
- NPI assigned
- Jul 19, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11716 | MN | |
| Physical Therapist | 225100000X | 2226 | ND | Primary |
Addresses
Primary practice location
Sanford Broadway Medical Building 736 Broadway N
Fargo, ND 58122-4001
Mailing address
Sanford Broadway Medical Building 736 Broadway N
Fargo, ND 58122-4001
Phone (701) 234-6735
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 |
|---|---|---|---|
| 11716 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718064000000",
"number": "1497278667",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "SANFORD BROADWAY MEDICAL BUILDING 736 BROADWAY N",
"city": "FARGO",
"state": "ND",
"postal_code": "581224001",
"telephone_number": "701-234-6735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "SANFORD BROADWAY MEDICAL BUILDING 736 BROADWAY N",
"city": "FARGO",
"state": "ND",
"postal_code": "581224001",
"telephone_number": "701-234-6735"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "ANDREW",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-19",
"last_updated": "2024-06-11",
"certification_date": "2024-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "11716",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ND",
"license": "2226",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.