Provider Demographics
NPI:1558501072
Name:PATTON, REGINA A (PT)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:A
Last Name:PATTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:A
Other - Last Name:LEHNERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5425 APPALACHIAN HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-8037
Mailing Address - Country:US
Mailing Address - Phone:706-632-8535
Mailing Address - Fax:706-632-8485
Practice Address - Street 1:5425 APPALACHIAN HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-8037
Practice Address - Country:US
Practice Address - Phone:706-632-8535
Practice Address - Fax:706-632-8485
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I659211OtherMEDICARE PTAN
GA701315331AMedicaid