Provider Demographics
NPI:1407894355
Name:REDMOND, GREGORY JAMES (DPT, CWS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JAMES
Last Name:REDMOND
Suffix:
Gender:M
Credentials:DPT, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 JORDAN ST STE 150
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4529
Mailing Address - Country:US
Mailing Address - Phone:318-344-1840
Mailing Address - Fax:800-959-0163
Practice Address - Street 1:820 JORDAN ST STE 150
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4529
Practice Address - Country:US
Practice Address - Phone:318-344-1840
Practice Address - Fax:800-959-0163
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1407894355Medicare PIN