Provider Demographics
NPI:1659137784
Name:O'REGAN, PARKER (DPT)
Entity Type:Individual
Prefix:
First Name:PARKER
Middle Name:
Last Name:O'REGAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W CALIFORNIA WAY
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-4001
Mailing Address - Country:US
Mailing Address - Phone:415-990-6144
Mailing Address - Fax:
Practice Address - Street 1:1821 SARATOGA AVE STE 100
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6605
Practice Address - Country:US
Practice Address - Phone:408-882-3453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist