Provider Demographics
NPI:1295214161
Name:RIVARD, REGINA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:RIVARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:MOROSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1111 ELM ST STE 9
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1540
Mailing Address - Country:US
Mailing Address - Phone:413-736-2250
Mailing Address - Fax:413-736-2254
Practice Address - Street 1:627 COLLEGE HWY STE 6
Practice Address - Street 2:
Practice Address - City:SOUTHWICK
Practice Address - State:MA
Practice Address - Zip Code:01077-9829
Practice Address - Country:US
Practice Address - Phone:413-736-2250
Practice Address - Fax:413-736-2254
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist