Provider Demographics
NPI:1528187598
Name:REDA, DANIELLE LYNN (PT)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:LYNN
Last Name:REDA
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 1:2551 N PARKDALE CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-6014
Mailing Address - Country:US
Mailing Address - Phone:316-773-4462
Mailing Address - Fax:
Practice Address - Street 1:9727 E SHANNON WOODS CIR
Practice Address - Street 2:SUITE#160
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4102
Practice Address - Country:US
Practice Address - Phone:316-681-0824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist