Healthcare Provider Details

I. General information

NPI: 1043791742
Provider Name (Legal Business Name): ANNA REDICK PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E MAIN ST STE 108
BOZEMAN MT
59715-3809
US

IV. Provider business mailing address

7 MINERAL AVE
BOZEMAN MT
59718-6249
US

V. Phone/Fax

Practice location:
  • Phone: 406-589-6083
  • Fax:
Mailing address:
  • Phone: 704-221-6492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34594
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT.9281
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: