Provider Demographics
NPI:1053410845
Name:YASSEM, RANDY LEE (CP CERT PROSTHETIST)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:LEE
Last Name:YASSEM
Suffix:
Gender:M
Credentials:CP CERT PROSTHETIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87067
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304
Mailing Address - Country:US
Mailing Address - Phone:910-323-9016
Mailing Address - Fax:910-486-8712
Practice Address - Street 1:234 OWEN DRIVE
Practice Address - Street 2:TOTAL REHAB OTHOTICS & PROSTHETICS INC
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-323-9016
Practice Address - Fax:910-486-8712
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795106Medicaid