Provider Demographics
NPI:1710161187
Name:MOTLEY, REGINA ANNE (MSPT, ATC)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:ANNE
Last Name:MOTLEY
Suffix:
Gender:F
Credentials:MSPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2090
Mailing Address - Country:US
Mailing Address - Phone:859-236-7012
Mailing Address - Fax:859-236-7407
Practice Address - Street 1:321 S 3RD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2090
Practice Address - Country:US
Practice Address - Phone:859-236-7012
Practice Address - Fax:859-236-7407
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist