Randall W Jerry (NPI# 1932624244, PAC ID# 2062779465) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICAL THERAPY.
| Nation Provider ID (NPI) | 1932624244 |
| PAC ID by PECOS | 2062779465 |
| Professional Enrollment ID | I20171120000838 |
| Full Name | Randall W Jerry |
| Organization Legal Name | PRO-ACTIVE REHAB, INC |
| Address |
640 Mlk Blvd Malvern AR 72104-2632 |
| Phone Number | 5014678275 |
| Gender | M |
| Graduation Year | 2017 |
| Primary Specialty | PHYSICAL THERAPY |
| Group Practice PAC ID | 2668482340 |
| Number of Group Practice Members | 8 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 640 Mlk Blvd, Malvern, AR 72104-2632 | 5014678275 | PRO-ACTIVE REHAB, INC |
| Organization Legal Name | PRO-ACTIVE REHAB, INC |
| Physicians | 9 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Krista J Koder | Physical Therapy | Pro-active Rehab, Inc | 1308 Military Rd, Benton, AR 72015-2911 |
| Nicholas G Dobbs | Physical Therapy | Pro-active Rehab, Inc | 640 Mlk Blvd, Malvern, AR 72104-2632 |
| Daniel B Myers Jr. | Physical Therapy | Pro-active Rehab, Inc | 1308 Military Rd, Benton, AR 72015-2911 |
| Michael Johnson | Physical Therapy | Pro-active Rehab, Inc | 1308 Military Rd, Benton, AR 72015-2911 |
| James R Lee | Physical Therapy | Pro-active Rehab, Inc | 1308 Military Rd, Benton, AR 72015-2911 |
| Sarah Mechelle Phillips | Physical Therapy | Pro-active Rehab, Inc | 1308 Military Rd, Benton, AR 72015-2911 |
| Mackenzie C Schluterman | Physical Therapy | Pro-active Rehab, Inc | 1308 Military Rd, Benton, AR 72015-2911 |
| Jenna L Mckiddy | Physical Therapy | Pro-active Rehab, Inc | 1308 Military Rd, Benton, AR 72015-2911 |
| Street Address |
640 MLK BLVD |
| City | MALVERN |
| State | AR |
| Zip | 72104-2632 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Nicholas G Dobbs | Physical Therapy | Pro-active Rehab, Inc | 640 Mlk Blvd, Malvern, AR 72104-2632 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Rimantas Kazakevicius | Family Medicine | Chi St Vincent Medical Group Hot Springs | 1424 Tanner St, Rockport, AR 72104-2082 |
| Michael R Schoultz | Physical Therapy | 1721 Martin Luther King Blvd I, Malvern, AR 72104-2087 | |
| Carrie E Cannon | Clinical Social Worker | Ouachita Regional Counseling and Mental Health Services, Inc | 1615 Martin Luther King Blvd, Malvern, AR 72104-2233 |
| Anthony Joel Valentine | Clinical Social Worker | Ouachita Regional Counseling and Mental Health Services, Inc | 1615 Martin Luther King Blvd, Malvern, AR 72104-2233 |
| Debra A Martinez | Clinical Social Worker | Ouachita Regional Counseling and Mental Health Services, Inc | 1615 Martin Luther King Blvd, Malvern, AR 72104-2233 |
| Brandi N Yarberry-rawls | Psychiatry | Ouachita Regional Counseling and Mental Health Center, Inc. | 1615 Martin Luther King Blvd, Malvern, AR 72104-2233 |
| Bethany S Cox | Nurse Practitioner | Tfs of Gurdon Inc | 829 Halbert St, Malvern, AR 72104-2607 |
| Mona R Simms | Nurse Practitioner | Shawn Purifoy Md Pa | 850 Henry St, Malvern, AR 72104-2712 |
| Anna Ross | Nurse Practitioner | Shawn Purifoy Md Pa | 850 Henry St, Malvern, AR 72104-2712 |
| Norinda Harrison | Nurse Practitioner | Shawn Purifoy Md Pa | 850 Henry St, Malvern, AR 72104-2712 |
| Find all physicians in zip 72104 | |||
| City | MALVERN |
| Zip Code | 72104 |
| Specialty | PHYSICAL THERAPY |
| City + Specialty | MALVERN + PHYSICAL THERAPY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.