Provider Demographics
NPI:1639273154
Name:BISSOON-REDD, KATRINA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:BISSOON-REDD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7404 EXECUTIVE PL
Mailing Address - Street 2:STE 300B
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2268
Mailing Address - Country:US
Mailing Address - Phone:301-599-9500
Mailing Address - Fax:301-856-7685
Practice Address - Street 1:7404 EXECUTIVE PL
Practice Address - Street 2:STE 300B
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2268
Practice Address - Country:US
Practice Address - Phone:301-599-9500
Practice Address - Fax:301-856-7685
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist