MEDICARE: REDDICK PHYSICAL THERAPY, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	J9294	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8A9795	OTHER	TX	MEDICARE
4	8G1486	OTHER	TX	MEDICARE UNSPECIFED
6	8G1887	OTHER	TX	MEDICARE ID UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8F7937	OTHER	TX	BCBS
3	0086KD	OTHER	TX	BCBS
5	8J8110	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1619152998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDDICK PHYSICAL THERAPY, P.A.

Provider Business Mailing Address
First Line	:	2300 VALLEY VIEW LN
Second Line	:	SUITE 1025
City	:	IRVING
State	:	TX
Zip	:	75062-5056
Country	:	US
Telephone Number	:	214-441-3046
Fax Number	:	214-441-3056

Provider Business Practice Location Address
First Line	:	2300 VALLEY VIEW LN
Second Line	:	SUITE 1025
City	:	IRVING
State	:	TX
Zip	:	75062-5056
Country	:	US
Telephone Number	:	214-441-3046
Fax Number	:	214-441-3056

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SYBIL ROCHELLE REDDICK
Credential	:	M.D.
Telephone Number	:	214-441-3046

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	01/11/2008

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Directions to “REDDICK PHYSICAL THERAPY, P.A. ” Practice Location

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