Active NPI
Kevin L Randall, PT
- Physical Therapist
- Columbus, MS
National Provider Identifier
1699759621
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT2980
- Practice address
- 670 Leigh Dr
Columbus, MS 39705-3014 - Phone
- (662) 328-1012
- Fax
- (662) 328-1507
- NPI assigned
- Dec 2, 2005
- Last updated
- Jan 15, 2015
- 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 | PT2980 | MS | Primary |
Addresses
Primary practice location
670 Leigh Dr
Columbus, MS 39705-3014
Mailing address
670 Leigh Dr
Columbus, MS 39705-3014
Phone (662) 328-1012
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03479811 | Medicaid | MS |
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 |
|---|---|---|---|
| PT2980 | MS | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421280000000",
"number": "1699759621",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "670 LEIGH DR",
"city": "COLUMBUS",
"state": "MS",
"postal_code": "397053014",
"telephone_number": "662-328-1012",
"fax_number": "662-328-1507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "670 LEIGH DR",
"city": "COLUMBUS",
"state": "MS",
"postal_code": "397053014",
"telephone_number": "662-328-1012",
"fax_number": "662-328-1507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "KEVIN",
"middle_name": "L",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-02",
"last_updated": "2015-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MS",
"license": "PT2980",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03479811",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbus, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.