Provider Demographics
NPI:1164452751
Name:BARR, RANDALL D (DPT, MS)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:D
Last Name:BARR
Suffix:
Gender:M
Credentials:DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 SE 143RD CT
Mailing Address - Street 2:
Mailing Address - City:MORRISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32668-4589
Mailing Address - Country:US
Mailing Address - Phone:662-801-7564
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:6550 SE 143RD CT
Practice Address - Street 2:
Practice Address - City:MORRISTON
Practice Address - State:FL
Practice Address - Zip Code:32668-4589
Practice Address - Country:US
Practice Address - Phone:662-801-7564
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3539225100000X
FLPT34432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07522770Medicaid