Provider Demographics
NPI:1629301239
Name:DEGNARS, REGINA MARIE (PTA)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:MARIE
Last Name:DEGNARS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-1918
Mailing Address - Country:US
Mailing Address - Phone:302-652-8554
Mailing Address - Fax:
Practice Address - Street 1:2 VILLAGE CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1918
Practice Address - Country:US
Practice Address - Phone:302-652-8554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI002216225200000X
DEJ20000559225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant