Healthcare Provider Details

I. General information

NPI: 1659016392
Provider Name (Legal Business Name): KEVIN REDDIG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44501 16TH ST W STE 107
LANCASTER CA
93534-2884
US

IV. Provider business mailing address

PO BOX 802227
SANTA CLARITA CA
91380-2227
US

V. Phone/Fax

Practice location:
  • Phone: 661-974-7033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number51731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: