Provider Demographics
NPI:1457328056
Name:HAGSTRAND, REGINA C (PT)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:C
Last Name:HAGSTRAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148-1649
Mailing Address - Country:US
Mailing Address - Phone:518-371-9572
Mailing Address - Fax:518-776-1064
Practice Address - Street 1:246 RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:REXFORD
Practice Address - State:NY
Practice Address - Zip Code:12148-1649
Practice Address - Country:US
Practice Address - Phone:518-371-9572
Practice Address - Fax:518-373-2063
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0041571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1093636Medicaid
NYR55297Medicare UPIN
NY1093636Medicaid