Provider Demographics
NPI:1043791742
Name:REDICK, ANNA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:REDICK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MINERAL AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6249
Mailing Address - Country:US
Mailing Address - Phone:704-221-6492
Mailing Address - Fax:
Practice Address - Street 1:777 E MAIN ST STE 108
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3809
Practice Address - Country:US
Practice Address - Phone:406-589-6083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT.92812251P0200X
FLPT34594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT34594OtherPT LICENSE
SCPT.9281OtherSOUTH CAROLINA PT LICENSE