Provider Demographics
NPI:1306194758
Name:REGINO, PAULA ERICKA AREVALO (RPT)
Entity Type:Individual
Prefix:MS
First Name:PAULA ERICKA
Middle Name:AREVALO
Last Name:REGINO
Suffix:
Gender:F
Credentials:RPT
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Mailing Address - Street 1:14205 PARK CENTER DR STE 204
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5252
Mailing Address - Country:US
Mailing Address - Phone:301-853-0093
Mailing Address - Fax:301-853-0096
Practice Address - Street 1:14300 GALLANT FOX LN STE 115
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4031
Practice Address - Country:US
Practice Address - Phone:301-853-0093
Practice Address - Fax:301-853-0096
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2023-10-25
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Provider Licenses
StateLicense IDTaxonomies
225100000X
MD26181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist