Active NPI
Randy Susan Demers, LICENSED PHYSICAL TH
- Physical Therapist
- Charlotte Hall, MD
National Provider Identifier
1982909487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 15538
- Practice address
- 29770 Three Notch Road
Charlotte Hall, MD 20622 - Phone
- (301) 290-0800
- Fax
- (301) 290-1313
- NPI assigned
- Jan 14, 2011
- Sex
- Female
- 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 | 15538 | MD | Primary |
Addresses
Primary practice location
29770 Three Notch Road
Charlotte Hall, MD 20622
Mailing address
11100 Budds Creek Road
Charlotte Hall, MD 20622
Phone (301) 290-0800
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15538 | MD | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coordinated Movements Inc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Speech-Language Pathologist
- Charlotte Hall, MD
- NPI 1659462133
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295568000000",
"number": "1982909487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11100 BUDDS CREEK ROAD",
"city": "CHARLOTTE HALL",
"state": "MD",
"postal_code": "20622",
"telephone_number": "301-290-0800",
"fax_number": "301-290-1313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29770 THREE NOTCH ROAD",
"city": "CHARLOTTE HALL",
"state": "MD",
"postal_code": "20622",
"telephone_number": "301-290-0800",
"fax_number": "301-290-1313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMERS",
"first_name": "RANDY",
"middle_name": "SUSAN",
"name_prefix": "Mrs.",
"credential": "LICENSED PHYSICAL TH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-14",
"last_updated": "2011-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "15538",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte Hall, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.