Provider Demographics
NPI:1003820267
Name:DI REDO, CHRISTOPHER NICOLAS (MPT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:NICOLAS
Last Name:DI REDO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 PARK AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3375
Mailing Address - Country:US
Mailing Address - Phone:209-723-8144
Mailing Address - Fax:209-723-5605
Practice Address - Street 1:2808 PARK AVE STE B
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3375
Practice Address - Country:US
Practice Address - Phone:209-723-8144
Practice Address - Fax:209-723-5605
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT299911Medicare ID - Type UnspecifiedPHYSICAL THERAPY MEDICARE