Provider Demographics
NPI:1770785834
Name:VEROLINE, RANDY (PTA)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:VEROLINE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PRIORY LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7110
Mailing Address - Country:US
Mailing Address - Phone:386-246-9855
Mailing Address - Fax:
Practice Address - Street 1:2810 W US HWY 64
Practice Address - Street 2:SUITE 1
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906
Practice Address - Country:US
Practice Address - Phone:828-837-0400
Practice Address - Fax:828-837-0404
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA10822225200000X
FLMA9393225700000X
NC3728225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist