Provider Demographics
NPI:1255318465
Name:REAGAN, LAURA B (PT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:B
Last Name:REAGAN
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:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:BYRDSTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38549-0368
Mailing Address - Country:US
Mailing Address - Phone:931-864-8090
Mailing Address - Fax:931-864-8091
Practice Address - Street 1:601 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:BYRDSTOWN
Practice Address - State:TN
Practice Address - Zip Code:38549-2418
Practice Address - Country:US
Practice Address - Phone:931-864-8090
Practice Address - Fax:931-864-8091
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000006366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4084962OtherBCBS
TN522444470OtherCENTER CARE
TN9358258OtherPHCS
TN1213804OtherCHA
TN4084962OtherTENNCARE
TNP00138386OtherRAILROAD MEDICARE
TN3659342Medicaid
TN6366OtherBLUEGRASS FAMILY HEALTH