Healthcare Provider Details

I. General information

NPI: 1013183110
Provider Name (Legal Business Name): TIMOTHY G REDFERN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 TAMMANY LANE
HAMILTON MT
59840-9216
US

IV. Provider business mailing address

472 TAMMANY LANE
HAMILTON MT
59840-9216
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-2816
  • Fax: 406-363-2816
Mailing address:
  • Phone: 406-363-2816
  • Fax: 406-363-2816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number290
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: