Provider Demographics
NPI:1740009745
Name:REDDICK, DINA LEE
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:LEE
Last Name:REDDICK
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 1:29911 N LEGENDS CHASE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386
Mailing Address - Country:US
Mailing Address - Phone:281-433-6460
Mailing Address - Fax:
Practice Address - Street 1:29911 N LEGENDS CHASE CIR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-2047
Practice Address - Country:US
Practice Address - Phone:281-433-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2105956208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation