Provider Demographics
NPI:1033383302
Name:REGALADO, EDWARD PAUL (MPT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:PAUL
Last Name:REGALADO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7100
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88355-7100
Mailing Address - Country:US
Mailing Address - Phone:575-257-5820
Mailing Address - Fax:575-257-9560
Practice Address - Street 1:628 SUDDERTH DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6204
Practice Address - Country:US
Practice Address - Phone:575-257-5820
Practice Address - Fax:575-257-9560
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM3426208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation