MEDICARE: CAROLE REDA PT

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	2305209430	VA

General Provider Information

NPI Number	:	1679951149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLE REDA PT

Provider Business Mailing Address
First Line	:	11960 LIONESS WAY STE 260
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80134-5640
Country	:	US
Telephone Number	:	303-344-9090
Fax Number	:	720-895-1121

Provider Business Practice Location Address
First Line	:	3253 TAYLOR RD STE 200A
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-2452
Country	:	US
Telephone Number	:	757-881-1137
Fax Number	:	757-881-1138

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

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	09/22/2023

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Directions to “ CAROLE REDA PT” Practice Location

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