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Individual
JASON REDEKER
Active
Individual
JASON REDEKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070016475
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113326
HEALTHLINK PROV ID
—
01
—
203
BLUE CROSS PROV ID
IL
01
—
4117
HAMP PROV ID
IL
01
—
7216
PERSONALCARE PROV ID
—
Enumeration date
10/30/2008
Last updated
04/27/2010
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