Provider Demographics
NPI:1134268196
Name:REDDINGTON, JACKIE L (MT)
Entity type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:L
Last Name:REDDINGTON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4067 E CALEY PL
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80121-3138
Mailing Address - Country:US
Mailing Address - Phone:303-220-1272
Mailing Address - Fax:
Practice Address - Street 1:4067 E CALEY PL
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80121-3138
Practice Address - Country:US
Practice Address - Phone:303-220-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist