Provider Demographics
NPI:1114988920
Name:REGNER, EDUARDO (PT)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:REGNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16740 BIRKDALE COMMONS PKWY STE 302
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-4463
Mailing Address - Country:US
Mailing Address - Phone:704-895-3636
Mailing Address - Fax:704-895-8436
Practice Address - Street 1:16740 BIRKDALE COMMONS PKWY STE 302
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4463
Practice Address - Country:US
Practice Address - Phone:704-895-3636
Practice Address - Fax:704-895-8436
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA8942Medicare ID - Type UnspecifiedMEDICARE NUMBER