Provider Demographics
NPI:1619007903
Name:REDMOND, MANDY R (AT)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:R
Last Name:REDMOND
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1572 ISLAND VIEW CT
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-2000
Mailing Address - Country:US
Mailing Address - Phone:208-642-1330
Mailing Address - Fax:
Practice Address - Street 1:1407 E HOMEDALE RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-1848
Practice Address - Country:US
Practice Address - Phone:208-459-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer