Basic Information
| Provider Information | |||||||||
| NPI: | 1306136072 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REDMOND | ||||||||
| FirstName: | WILLIAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 637 COUNTY ROUTE 11 | ||||||||
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| City: | GOUVERNEUR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136423109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867564395 | ||||||||
| FaxNumber: | 3869447202 | ||||||||
| Practice Location | |||||||||
| Address1: | 917 BEVILLE RD | ||||||||
| Address2: | SUITE G | ||||||||
| City: | SOUTH DAYTONA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321191712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867564395 | ||||||||
| FaxNumber: | 3869447202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2011 | ||||||||
| LastUpdateDate: | 04/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | TEI002733 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.