Provider Demographics
NPI:1376718643
Name:REDFERN, MARIA (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:REDFERN
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 1:400 W MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2439
Mailing Address - Country:US
Mailing Address - Phone:406-363-2494
Mailing Address - Fax:406-363-7232
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2439
Practice Address - Country:US
Practice Address - Phone:406-363-2494
Practice Address - Fax:406-363-7232
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist