Provider Demographics
NPI:1326401894
Name:REDDEN, GWENDOLYN (PT)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:REDDEN
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:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736-0174
Mailing Address - Country:US
Mailing Address - Phone:301-802-5310
Mailing Address - Fax:
Practice Address - Street 1:8420 BAYSIDE RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE BEACH
Practice Address - State:MD
Practice Address - Zip Code:20732
Practice Address - Country:US
Practice Address - Phone:443-964-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist