Provider Demographics
NPI:1154801967
Name:REDIKER, DANIELLE M (DPT)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:M
Last Name:REDIKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1468
Mailing Address - Country:US
Mailing Address - Phone:516-672-1182
Mailing Address - Fax:
Practice Address - Street 1:25 LINDSLEY DRIVE MORRISTOWN, NJ 07960
Practice Address - Street 2:207
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:732-224-1280
Practice Address - Fax:732-224-1281
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01491200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist