Provider Demographics
NPI:1104622299
Name:REDSTONE, INA E (LMT)
Entity type:Individual
Prefix:
First Name:INA
Middle Name:E
Last Name:REDSTONE
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:INA
Other - Middle Name:E
Other - Last Name:BUEHNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:5 EXECUTIVE WOODS COURT
Mailing Address - Street 2:UNITED C - INDIGO SUITE
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 EXECUTIVE WOODS COURT
Practice Address - Street 2:UNITED C - INDIGO SUITE
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-444-8986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024041711225700000X
IL227.023898225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist