Provider Demographics
NPI:1275898660
Name:REAGAN, MARGARET E (PT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:E
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 1:1089 HEMINGWAY N
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-9201
Mailing Address - Country:US
Mailing Address - Phone:217-617-9378
Mailing Address - Fax:
Practice Address - Street 1:1089 HEMINGWAY N
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-9201
Practice Address - Country:US
Practice Address - Phone:217-617-9378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-5458Medicare PIN