Provider Demographics
NPI:1356481212
Name:REDLICH, NANCY PAULINE (MSPT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:PAULINE
Last Name:REDLICH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1142
Mailing Address - Country:US
Mailing Address - Phone:760-434-8149
Mailing Address - Fax:
Practice Address - Street 1:2060 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1142
Practice Address - Country:US
Practice Address - Phone:760-434-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA186572251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic