Provider Demographics
NPI:1003490525
Name:REGAN, KEELYMAE J (DPT)
Entity Type:Individual
Prefix:
First Name:KEELYMAE
Middle Name:J
Last Name:REGAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 S LAVENTURE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-6033
Mailing Address - Country:US
Mailing Address - Phone:360-424-7041
Mailing Address - Fax:360-424-2418
Practice Address - Street 1:1500 CONTINENTAL PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4105
Practice Address - Country:US
Practice Address - Phone:360-424-7041
Practice Address - Fax:360-424-2456
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPT61179361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist