Provider Demographics
NPI:1750636619
Name:REDWINE, BRITTNEY (DPT)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:REDWINE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BRITTNEY
Other - Middle Name:
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5217 82ND ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2827
Mailing Address - Country:US
Mailing Address - Phone:806-687-4311
Mailing Address - Fax:806-687-4313
Practice Address - Street 1:5217 82ND ST
Practice Address - Street 2:SUITE 104
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2827
Practice Address - Country:US
Practice Address - Phone:806-687-4311
Practice Address - Fax:806-687-4313
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1219252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist