Provider Demographics
NPI:1760629406
Name:TIMOTHY A REDMAN PH D LLC
Entity Type:Organization
Organization Name:TIMOTHY A REDMAN PH D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:REDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:941-951-0343
Mailing Address - Street 1:3344 BAHIA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-7386
Mailing Address - Country:US
Mailing Address - Phone:941-951-0343
Mailing Address - Fax:866-601-3427
Practice Address - Street 1:3344 BAHIA VISTA ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-7386
Practice Address - Country:US
Practice Address - Phone:941-951-0343
Practice Address - Fax:866-601-3427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3846251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health