Provider Demographics
NPI:1639621873
Name:REDD, CARDELL
Entity Type:Individual
Prefix:
First Name:CARDELL
Middle Name:
Last Name:REDD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25132 OAKHURST DR
Mailing Address - Street 2:SUITE NUMBER 195
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1452
Mailing Address - Country:US
Mailing Address - Phone:281-298-5020
Mailing Address - Fax:281-298-5021
Practice Address - Street 1:25132 OAKHURST DR
Practice Address - Street 2:SUITE NUMBER 195
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1452
Practice Address - Country:US
Practice Address - Phone:281-298-5020
Practice Address - Fax:281-298-5021
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2047835225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant