Provider Demographics
NPI:1891859013
Name:REDMAN, NATHAN KEITH (PT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:KEITH
Last Name:REDMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 VIVIAL RD
Mailing Address - Street 2:
Mailing Address - City:SCHULENBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78956-5158
Mailing Address - Country:US
Mailing Address - Phone:979-562-2862
Mailing Address - Fax:
Practice Address - Street 1:105 BOEHM DR
Practice Address - Street 2:
Practice Address - City:SHINER
Practice Address - State:TX
Practice Address - Zip Code:77984-6288
Practice Address - Country:US
Practice Address - Phone:361-594-8301
Practice Address - Fax:361-594-3033
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1146482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2716OtherBCBS PROVIDER NUMBER
TX0077402OtherBLUE LINK NUMBER