Forrest Redd, PHYSICAL THERAPIST
Individual provider Active NPI Physical Therapy Assistant · Buffalo, IL
NPI 1780969337 · NPPES record last updated Oct 14, 2011
Key facts
- NPI
- 1780969337
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 160.001902 (IL)
- Practice address
- 100 S Main St
Buffalo, IL 62515-6225 - Phone
- (217) 502-7253
- NPI assigned
- Oct 14, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160.001902 | IL | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160.001902 | IL | Yes |
Addresses
Primary practice location
100 S Main St
Buffalo, IL 62515-6225
Mailing address
100 S Main St
Buffalo, IL 62515-6225
Other providers in Buffalo, IL
All providers in Buffalo, IL · Physical Therapy Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.