Healthcare Provider Details

I. General information

NPI: 1184114944
Provider Name (Legal Business Name): JOHN REDDON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 W MAIN ST
RIVERTON WY
82501-3239
US

IV. Provider business mailing address

1406 W MAIN ST
RIVERTON WY
82501-3239
US

V. Phone/Fax

Practice location:
  • Phone: 307-857-7074
  • Fax: 307-856-6459
Mailing address:
  • Phone: 307-857-7074
  • Fax: 307-856-6459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberCE262879
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1798
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: