Provider Demographics
NPI:1275946832
Name:ORRELL, REGINA (DPT)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:ORRELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 NW R D MIZE RD
Mailing Address - Street 2:SUITE B203
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2527
Mailing Address - Country:US
Mailing Address - Phone:816-220-1312
Mailing Address - Fax:
Practice Address - Street 1:220 NW R D MIZE RD
Practice Address - Street 2:SUITE B203
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2527
Practice Address - Country:US
Practice Address - Phone:816-220-1312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1104864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist