Healthcare Provider Details

I. General information

NPI: 1376502856
Provider Name (Legal Business Name): NANCY REDICK P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 RIDGE RD
ONTARIO NY
14519-9101
US

IV. Provider business mailing address

3 WEST AVE
LE ROY NY
14482-1381
US

V. Phone/Fax

Practice location:
  • Phone: 315-524-9735
  • Fax: 315-524-4423
Mailing address:
  • Phone: 315-524-9735
  • Fax: 315-524-4423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number025864-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: