Active NPI
Iran Redden
- Physical Therapy Assistant
- Heathrow, FL
National Provider Identifier
1447489398
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 000719
- Practice address
- 1485 International Pkwy
Heathrow, FL 32746-5303 - Phone
- (800) 798-6035
- Fax
- (888) 798-6035
- NPI assigned
- Jul 13, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 000719 | GA | Primary |
Addresses
Primary practice location
1485 International Pkwy
Heathrow, FL 32746-5303
Mailing address
1485 International Pkwy
Heathrow, FL 32746-5303
Phone (800) 798-6035
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000719 | GA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247443200000",
"number": "1447489398",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1485 INTERNATIONAL PKWY",
"city": "HEATHROW",
"state": "FL",
"postal_code": "327465303",
"telephone_number": "800-798-6035",
"fax_number": "888-798-6035"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1485 INTERNATIONAL PKWY",
"city": "HEATHROW",
"state": "FL",
"postal_code": "327465303",
"telephone_number": "800-798-6035",
"fax_number": "888-798-6035"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REDDEN",
"first_name": "IRAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-13",
"last_updated": "2009-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "GA",
"license": "000719",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Heathrow, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.