Provider Demographics
NPI:1679053789
Name:REDINGER, DAVID (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:REDINGER
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4493 N FIFESHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-9559
Mailing Address - Country:US
Mailing Address - Phone:509-961-7341
Mailing Address - Fax:
Practice Address - Street 1:3409 N WHISTLER LN APT 201
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-6298
Practice Address - Country:US
Practice Address - Phone:509-961-7341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-7552255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer