Provider Demographics
NPI:1912244294
Name:REDING, JACKIE F (PTA)
Entity type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:F
Last Name:REDING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:FRANCES
Other - Middle Name:J
Other - Last Name:REDING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:1626 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NEODESHA
Mailing Address - State:KS
Mailing Address - Zip Code:66757-1239
Mailing Address - Country:US
Mailing Address - Phone:620-330-0054
Mailing Address - Fax:
Practice Address - Street 1:1626 N 8TH ST
Practice Address - Street 2:
Practice Address - City:NEODESHA
Practice Address - State:KS
Practice Address - Zip Code:66757-1239
Practice Address - Country:US
Practice Address - Phone:620-330-0054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1400789225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant