Provider Demographics
NPI:1538777941
Name:REDDER, ANGELA NICOLE (LMT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:NICOLE
Last Name:REDDER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2243 HIAWATHA CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1840
Mailing Address - Country:US
Mailing Address - Phone:970-214-8513
Mailing Address - Fax:
Practice Address - Street 1:113 5TH ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5107
Practice Address - Country:US
Practice Address - Phone:970-342-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0022820225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist