Provider Demographics
NPI:1861692915
Name:REDDINGTON, JOSEPH RAYMOND (PT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RAYMOND
Last Name:REDDINGTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 SE BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-5302
Mailing Address - Country:US
Mailing Address - Phone:714-546-5433
Mailing Address - Fax:717-546-8616
Practice Address - Street 1:1182 SE BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-5302
Practice Address - Country:US
Practice Address - Phone:717-546-5433
Practice Address - Fax:714-546-8616
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23061OtherLICENSE