Provider Demographics
NPI:1164427720
Name:REGALADO, DONNA B (PT)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:B
Last Name:REGALADO
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3018 FESTIVAL WAY
Practice Address - Street 2:#323
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2958
Practice Address - Country:US
Practice Address - Phone:240-754-5520
Practice Address - Fax:301-705-6797
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18306225100000X
DC870153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
46950046OtherCAREFIRST NCA
890199-04OtherCAREFIRST OF MARYLAND