Provider Demographics
NPI:1114182524
Name:REDWINE, PAT MALONE (PT)
Entity Type:Individual
Prefix:
First Name:PAT
Middle Name:MALONE
Last Name:REDWINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 OXMOOR CT
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6341
Mailing Address - Country:US
Mailing Address - Phone:205-945-0426
Mailing Address - Fax:
Practice Address - Street 1:110 OXMOOR CT
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6341
Practice Address - Country:US
Practice Address - Phone:205-945-0426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist