Provider Demographics
NPI:1427121953
Name:RANDALL, TONI LEE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:TONI
Middle Name:LEE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4570 HILLAND DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4529
Mailing Address - Country:US
Mailing Address - Phone:216-741-4378
Mailing Address - Fax:216-741-4396
Practice Address - Street 1:35104 EUCLID AVE
Practice Address - Street 2:SUITE #311
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4516
Practice Address - Country:US
Practice Address - Phone:440-954-7061
Practice Address - Fax:440-954-7065
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01123225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant