Provider Demographics
NPI:1437356631
Name:ISEMAN, REGINA MARY (PT)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MARY
Last Name:ISEMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:REGINA
Other - Middle Name:MARY
Other - Last Name:DOANATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45551 MOUND RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-5100
Practice Address - Country:US
Practice Address - Phone:586-323-9224
Practice Address - Fax:586-323-9226
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6211048Medicare PIN