Provider Demographics
NPI:1114987294
Name:REDDEN, RONALD RICHARD (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:RICHARD
Last Name:REDDEN
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 REMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76131-4813
Mailing Address - Country:US
Mailing Address - Phone:817-306-1815
Mailing Address - Fax:
Practice Address - Street 1:800 N BLUE MOUND RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76131-1052
Practice Address - Country:US
Practice Address - Phone:817-306-0914
Practice Address - Fax:817-847-7629
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT19272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer