Healthcare Provider Details

I. General information

NPI: 1144399106
Provider Name (Legal Business Name): REDDING FUNCTIONAL RESTORATION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 CHURN CREEK RD.
REDDING CA
96002
US

IV. Provider business mailing address

1135 WHISKEYTOWN CT
REDDING CA
96001-0227
US

V. Phone/Fax

Practice location:
  • Phone: 530-245-5985
  • Fax: 530-245-0539
Mailing address:
  • Phone: 530-245-5985
  • Fax: 530-245-0539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberG85748
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL ROY MOORE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 530-245-5985