Individual ProviderTerry L RandallPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address175 Medpark Dr, Somerset, KY 42503-2734(606) 679-1761PECOS EnrollmentBased on the most recent information from CMS, provider Terry L Randall does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1164457321Provider TypeIndividualFull NameRandall, Terry LTitleMr.CredentialDPTGenderMaleSole ProprietorNoEnumeration Date7/12/2006Last Updated7/16/2014Contact InformationPractice LocationPractice Address175 Medpark Dr, Somerset, KY 42503-2734Phone(606) 679-1761Fax(606) 678-0971Mailing LocationMailing Address175 Medpark Dr, Somerset, KY 42503-2734Phone(606) 679-1761Fax(606) 678-0971Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense003180KentuckyCode2255A2300XDescriptionSpecialist/TechnologistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicenseAT361KentuckyProvider IdentifiersIDDescriptionIssuerID87031803DescriptionMedicaidIssuerUnlistedKentuckyID000000225912DescriptionOtherIssuerBCBS PROVIDER NUMBERKentucky