Provider Demographics
NPI:1982848511
Name:REDIG, PHILIP G (LMT)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:G
Last Name:REDIG
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 E MICHIGAN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2700
Mailing Address - Country:US
Mailing Address - Phone:407-275-3994
Mailing Address - Fax:407-275-9395
Practice Address - Street 1:5555 E MICHIGAN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2700
Practice Address - Country:US
Practice Address - Phone:407-275-3994
Practice Address - Fax:407-275-9395
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47524225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist