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NPI Code Detail

MEDICARE: MR. KELVIN REDDICK PHYSICAL THERAPIST

MEDICARE: MR. KELVIN REDDICK PHYSICAL THERAPIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist4429FL
2225100000XPhysical Therapist2231GA

General Provider Information

NPI Number : 1629349626
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KELVIN REDDICK PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 3101 GINGER DR
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-4437
Country : US
Telephone Number : 850-877-2177
Fax Number : 850-942-7237
Provider Business Practice Location Address
First Line : 3101 GINGER DR
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-4437
Country : US
Telephone Number : 850-877-2177
Fax Number : 850-942-7237
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2012
Last Update Date : 01/23/2012

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