Basic Information
| Provider Information | |||||||||
| NPI: | 1679951149 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REDA | ||||||||
| FirstName: | CAROLE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11960 LIONESS WAY STE 260 | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801345640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033449090 | ||||||||
| FaxNumber: | 7208951121 | ||||||||
| Practice Location | |||||||||
| Address1: | 11960 LIONESS WAY STE 260 | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801345640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033449090 | ||||||||
| FaxNumber: | 7208951121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2015 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305209430 | VA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PTL.0014211 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.