Provider Demographics
NPI:1538241450
Name:RANDALL, BRENNA C (PT)
Entity type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:C
Last Name:RANDALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:BRENNA
Other - Middle Name:C
Other - Last Name:RICHMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1347 SW COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-2619
Mailing Address - Country:US
Mailing Address - Phone:785-213-0822
Mailing Address - Fax:785-235-2803
Practice Address - Street 1:1347 SW COLLINS AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-2619
Practice Address - Country:US
Practice Address - Phone:785-213-0822
Practice Address - Fax:785-235-2803
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-004002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics