Provider Demographics
NPI:1457351447
Name:REDFERN, GREGORY J (PT)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:J
Last Name:REDFERN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 RAMSEY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5808
Mailing Address - Country:US
Mailing Address - Phone:541-476-1919
Mailing Address - Fax:541-476-1920
Practice Address - Street 1:625 RAMSEY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5808
Practice Address - Country:US
Practice Address - Phone:541-476-1919
Practice Address - Fax:541-476-1920
Is Sole Proprietor?:No
Enumeration Date:2005-07-31
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182072Medicaid
OR1897777OtherUNITED HEALTH CARE INSURA
ORJ284203OtherPACIFIC SOURCE INSURANCE
ORJ284203OtherPACIFIC SOURCE INSURANCE