Provider Demographics
NPI:1780891093
Name:REDONNET, EDWARD CHARLES I (MSPT)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:CHARLES
Last Name:REDONNET
Suffix:I
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:CHARLES
Other - Last Name:REDONNET
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:MSPT
Mailing Address - Street 1:180 MONTAGUE RD
Mailing Address - Street 2:
Mailing Address - City:SHUTESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01072-9717
Mailing Address - Country:US
Mailing Address - Phone:413-259-1928
Mailing Address - Fax:
Practice Address - Street 1:180 MONTAGUE RD
Practice Address - Street 2:
Practice Address - City:SHUTESBURY
Practice Address - State:MA
Practice Address - Zip Code:01072-9717
Practice Address - Country:US
Practice Address - Phone:413-259-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69479Medicare ID - Type UnspecifiedMEDICARE PROVIDER#
MA0707627Medicare UPIN
MAAA28204Medicare UPIN
MAY68405Medicare UPIN