MEDICARE: CHRISTINE REDOVIAN P.T.

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
1	225100000X	Physical Therapist	PT004107	GA

General Provider Information

NPI Number	:	1649340928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE REDOVIAN P.T.

Provider Business Mailing Address
First Line	:	3656 STARWOOD TRL SW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-2448
Country	:	US
Telephone Number	:	678-362-8652
Fax Number	:	770-985-3656

Provider Business Practice Location Address
First Line	:	4310 JOHNS CREEK PKWY
Second Line	:	100
City	:	SUWANEE
State	:	GA
Zip	:	30024-6091
Country	:	US
Telephone Number	:	770-814-2900
Fax Number	:	770-814-7790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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