Provider Demographics
NPI:1194611673
Name:RICHMOND, RANDIE
Entity type:Individual
Prefix:
First Name:RANDIE
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 ELM ST STE 230
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3686
Mailing Address - Country:US
Mailing Address - Phone:563-583-4003
Mailing Address - Fax:563-583-3408
Practice Address - Street 1:1690 ELM ST STE 230
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3686
Practice Address - Country:US
Practice Address - Phone:563-583-4003
Practice Address - Fax:563-583-3408
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA131854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist