Green, Randall
Green, Randall is an individual health care provider with primary practice located at 1115 Ferguson Dr , Benton AR 72015-3512. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Green, Randall can be contacted via phone (501) 315-0639.Contact Information
Primary practice address
1115 Ferguson Dr
Benton AR 72015-3512
Phone: (501) 315-0639
Fax: (501) 315-7278
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | AR482 | Arkansas |
Profile Details
| NPI number | 1457352056 |
|---|---|
| LBN Legal business name | Green, Randall |
| Credentials | Physical Therapist (PT) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 3rd, 2005 |
| Last updated | Jun 5th, 2008 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1457352056 | NPPES |
| Alaska | MEDICAID | 117798721 |
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