Provider Demographics
NPI:1093091134
Name:REDDING, GREGORY (DPT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:REDDING
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HATFIELD LN
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6766
Mailing Address - Country:US
Mailing Address - Phone:845-615-2222
Mailing Address - Fax:
Practice Address - Street 1:30 HATFIELD LN
Practice Address - Street 2:SUITE 203
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6766
Practice Address - Country:US
Practice Address - Phone:845-615-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist