Provider Demographics
NPI:1962034256
Name:REDMOND, DENNIS JOHN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JOHN
Last Name:REDMOND
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6546 ENGLISH OAKS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6326
Mailing Address - Country:US
Mailing Address - Phone:919-457-6333
Mailing Address - Fax:
Practice Address - Street 1:6905 KNIGHTDALE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6506
Practice Address - Country:US
Practice Address - Phone:919-373-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist