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General NPI Number Information
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NPI Number | 1619283215
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Entity Type | Individual
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Provider Name | PATRICIA ANN REDFEARN LMT
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Gender | Male
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Dates
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Enumeration Date | 08/20/2010
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Last Update Date | 08/20/2010
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Provider Practice Location Address
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Address Line | 878 N GRAND AVE NW
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City | ATLANTA
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State | GA
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Zip | 30318-4707
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Country | US
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Telephone | 404-671-2376
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Fax |
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Provider Business Mailing Address
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Address Line | 3644 CHAMBLEE TUCKER RD SUITE B
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City | CHAMBLEE
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State | GA
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Zip | 30341-4405
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Country | US
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Telephone | 770-723-7770
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Fax | 770-491-1001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT005881
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License Number State | GA
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