Provider Demographics
NPI:1255670733
Name:REDLITZ, ANDREA WINSOR
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:WINSOR
Last Name:REDLITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2057 EPSILON CT
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-6008
Mailing Address - Country:US
Mailing Address - Phone:904-264-8870
Mailing Address - Fax:
Practice Address - Street 1:2057 EPSILON CT
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-6008
Practice Address - Country:US
Practice Address - Phone:904-264-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist