Provider Demographics
NPI:1568273548
Name:ASILO, RANDOLPH (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:
Last Name:ASILO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 WOOD SORREL ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2058
Mailing Address - Country:US
Mailing Address - Phone:951-233-0480
Mailing Address - Fax:
Practice Address - Street 1:2702 WOOD SORREL ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-2058
Practice Address - Country:US
Practice Address - Phone:951-233-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist