Provider Demographics
NPI:1053921544
Name:FRENCH, MISTY DAWN (PT)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:FRENCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16990 PINE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-1033
Mailing Address - Country:US
Mailing Address - Phone:719-238-2331
Mailing Address - Fax:
Practice Address - Street 1:2051 HILLTOP DR STE A8
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0214
Practice Address - Country:US
Practice Address - Phone:719-238-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT291595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT291595OtherLICENSE NUMBER
KS2900OtherNUMBERLICENSE
MO110372OtherSTATE LICENSURE
CO7200OtherLICENSE NUMBER