Provider Demographics
NPI:1215478615
Name:RATH, RANDI (PA-C)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:RATH
Suffix:
Gender:F
Credentials:PA-C
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 400
Mailing Address - Street 2:
Mailing Address - City:SCOBEY
Mailing Address - State:MT
Mailing Address - Zip Code:59263-0400
Mailing Address - Country:US
Mailing Address - Phone:406-487-2296
Mailing Address - Fax:406-487-2680
Practice Address - Street 1:105 5TH AVE E
Practice Address - Street 2:
Practice Address - City:SCOBEY
Practice Address - State:MT
Practice Address - Zip Code:59263
Practice Address - Country:US
Practice Address - Phone:406-487-2296
Practice Address - Fax:406-487-2680
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-17
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT55812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant