| NPI | 1588359624 |
|---|---|
| Former Name | COURTNEY RANDOLPH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29702) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT004644) |
| 261QP2000X Clinic/Center, Physical Therapy | |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2025-07-31 |