Provider Demographics
NPI:1386818631
Name:REGAN, BRIAN KEITH (PT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:REGAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23852 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1829
Mailing Address - Country:US
Mailing Address - Phone:313-565-4222
Mailing Address - Fax:
Practice Address - Street 1:1845 LIVERNOIS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1731
Practice Address - Country:US
Practice Address - Phone:248-362-2150
Practice Address - Fax:248-362-1702
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist