Provider Demographics
NPI:1598145815
Name:DREW-REGAN, STACEY (DPT)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:DREW-REGAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SUNSHINE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOLDIERS GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:54655-7106
Mailing Address - Country:US
Mailing Address - Phone:608-624-5244
Mailing Address - Fax:608-624-3478
Practice Address - Street 1:101 SUNSHINE BLVD
Practice Address - Street 2:
Practice Address - City:SOLDIERS GROVE
Practice Address - State:WI
Practice Address - Zip Code:54655-7106
Practice Address - Country:US
Practice Address - Phone:608-624-5244
Practice Address - Fax:608-624-3478
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12979-242251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics