Provider Demographics
NPI:1649482613
Name:INCARDONA, RANDI MITCHELL (PT)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:MITCHELL
Last Name:INCARDONA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19227
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34276-2227
Mailing Address - Country:US
Mailing Address - Phone:941-926-3363
Mailing Address - Fax:941-926-3342
Practice Address - Street 1:3943 CLARK RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2364
Practice Address - Country:US
Practice Address - Phone:941-926-3363
Practice Address - Fax:941-926-3342
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT00004610174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist