Provider Demographics
NPI:1699166900
Name:REDING, JEFF
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:REDING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N 18TH STREET
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125
Mailing Address - Country:US
Mailing Address - Phone:515-341-2486
Mailing Address - Fax:
Practice Address - Street 1:302 N 18TH ST
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-9720
Practice Address - Country:US
Practice Address - Phone:515-341-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004865261QP2000X
IL160.006573261QP2000X
TX2099533261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy