Provider Demographics
NPI:1619152998
Name:REDDICK PHYSICAL THERAPY, P.A.
Entity Type:Organization
Organization Name:REDDICK PHYSICAL THERAPY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYBIL
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:REDDICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-441-3046
Mailing Address - Street 1:2300 VALLEY VIEW LN
Mailing Address - Street 2:SUITE 1025
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-5056
Mailing Address - Country:US
Mailing Address - Phone:214-441-3046
Mailing Address - Fax:214-441-3056
Practice Address - Street 1:2300 VALLEY VIEW LN
Practice Address - Street 2:SUITE 1025
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5056
Practice Address - Country:US
Practice Address - Phone:214-441-3046
Practice Address - Fax:214-441-3056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9294174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A9795OtherMEDICARE
TX8F7937OtherBCBS
TX0086KDOtherBCBS
TX8G1486OtherMEDICARE UNSPECIFED
TX8J8110OtherBCBS
TX8G1887OtherMEDICARE ID UNSPECIFIED
TX8G1887OtherMEDICARE ID UNSPECIFIED