Provider Demographics
NPI:1265864565
Name:REGAN, LAURA T (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:T
Last Name:REGAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 EAGLE ST
Mailing Address - Street 2:WISE PHYSICAL THERAPY & REHABILITATION INC
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2818
Mailing Address - Country:US
Mailing Address - Phone:907-562-2118
Mailing Address - Fax:907-562-2128
Practice Address - Street 1:17101 SNOWMOBILE LN STE 202
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7043
Practice Address - Country:US
Practice Address - Phone:907-694-8085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist