Provider Demographics
NPI:1558453316
Name:MOURADIAN, REGINA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:
Last Name:MOURADIAN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36A ROSEMARY AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2523
Mailing Address - Country:US
Mailing Address - Phone:781-224-9896
Mailing Address - Fax:781-246-1098
Practice Address - Street 1:384 LOWELL ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1986
Practice Address - Country:US
Practice Address - Phone:781-246-2266
Practice Address - Fax:781-246-1098
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist