Provider Demographics
NPI:1295018349
Name:OSTERLOO, RANDI RICHELLE (PT)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:RICHELLE
Last Name:OSTERLOO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 URBANA PIKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:IJAMSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21754-9406
Mailing Address - Country:US
Mailing Address - Phone:301-874-2226
Mailing Address - Fax:301-874-5955
Practice Address - Street 1:3280 URBANA PIKE
Practice Address - Street 2:SUITE 202
Practice Address - City:IJAMSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21754-9406
Practice Address - Country:US
Practice Address - Phone:301-874-2226
Practice Address - Fax:301-874-5955
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist