Provider Demographics
NPI:1982050712
Name:RANDAL DENTON ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:RANDAL DENTON ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:N
Authorized Official - Last Name:DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS, DPT
Authorized Official - Phone:214-618-2424
Mailing Address - Street 1:5454 SURREY PATH STE 103
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9581
Mailing Address - Country:US
Mailing Address - Phone:214-618-2424
Mailing Address - Fax:214-618-2432
Practice Address - Street 1:5454 SURREY PATH STE 103
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:214-618-2424
Practice Address - Fax:214-618-2432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89896TOtherBCBS
TX471157ZS1MMedicare PIN
TX470447Medicare PIN