Provider Demographics
NPI:1598749376
Name:ALDRIDGE, RANDAL JAY (MS PT ATC)
Entity type:Individual
Prefix:MR
First Name:RANDAL
Middle Name:JAY
Last Name:ALDRIDGE
Suffix:
Gender:M
Credentials:MS PT ATC
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Mailing Address - Street 1:2000 WESTINGHOUSE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5238
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:
Practice Address - Street 1:2408 E UNIVERSITY DR STE 106
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-9404
Practice Address - Country:US
Practice Address - Phone:334-275-4636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5136225100000X
ALPTH 18202251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q33973Medicare UPIN