Provider Demographics
NPI:1649590530
Name:REGER ENTERPRISES, LLC
Entity Type:Organization
Organization Name:REGER ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORTLAND
Authorized Official - Middle Name:JON
Authorized Official - Last Name:REGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC, OCS
Authorized Official - Phone:907-382-5142
Mailing Address - Street 1:PO BOX 242131
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-2131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:510 W TUDOR RD STE 2
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6649
Practice Address - Country:US
Practice Address - Phone:907-382-5142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK943621261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy