Provider Demographics
NPI:1104826932
Name:REDMOND, GABRIEL J (PT)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:J
Last Name:REDMOND
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 1:29 FODEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-1706
Mailing Address - Country:US
Mailing Address - Phone:207-772-2625
Mailing Address - Fax:207-879-4246
Practice Address - Street 1:29 FODEN RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1706
Practice Address - Country:US
Practice Address - Phone:207-772-2625
Practice Address - Fax:207-879-4246
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME027896OtherBC/BS OF MAINE
ME027896OtherBC/BS OF MAINE