Provider Demographics
NPI:1679951149
Name:REDA, CAROLE (PT)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:
Last Name:REDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11960 LIONESS WAY STE 260
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5640
Mailing Address - Country:US
Mailing Address - Phone:303-344-9090
Mailing Address - Fax:720-895-1121
Practice Address - Street 1:3253 TAYLOR RD STE 200A
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2452
Practice Address - Country:US
Practice Address - Phone:757-881-1137
Practice Address - Fax:757-881-1138
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209430225100000X
COPTL.0014211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist