Basic Information
| Provider Information | |||||||||
| NPI: | 1578813515 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RANDELS KOTES | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | MARGARET | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 890 LANCASTER AVE | ||||||||
| Address2: | |||||||||
| City: | DEVON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193332360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102252451 | ||||||||
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| Practice Location | |||||||||
| Address1: | 541 N FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | SHAMOKIN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178726754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706442000 | ||||||||
| FaxNumber: | 5706449801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2012 | ||||||||
| LastUpdateDate: | 12/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT011988L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.