Provider Demographics
NPI:1083476949
Name:REDMON, MACY JAYE
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:JAYE
Last Name:REDMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485
Mailing Address - Country:US
Mailing Address - Phone:931-722-2778
Mailing Address - Fax:
Practice Address - Street 1:129 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38310-2203
Practice Address - Country:US
Practice Address - Phone:731-632-0535
Practice Address - Fax:731-632-0510
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8131225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant