Provider Demographics
NPI:1225248016
Name:HARTIN, REGINA RENEE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:RENEE
Last Name:HARTIN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-3878
Mailing Address - Country:US
Mailing Address - Phone:618-416-0174
Mailing Address - Fax:
Practice Address - Street 1:341 S SAPPINGTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-6331
Practice Address - Country:US
Practice Address - Phone:314-984-2825
Practice Address - Fax:314-966-4662
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer