Healthcare Provider Details

I. General information

NPI: 1831002104
Provider Name (Legal Business Name): JOSHUA REDMOND
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 NATRONA DR
NORTH PORT FL
34286-8004
US

IV. Provider business mailing address

1116 NATRONA DR
NORTH PORT FL
34286-8004
US

V. Phone/Fax

Practice location:
  • Phone: 415-601-2218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA110387
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: