Provider Demographics
NPI:1780021220
Name:REGANA, WALTER ANTHONY
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:ANTHONY
Last Name:REGANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-4393
Mailing Address - Country:US
Mailing Address - Phone:337-310-8500
Mailing Address - Fax:888-241-3028
Practice Address - Street 1:114 WHATLEY ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-3318
Practice Address - Country:US
Practice Address - Phone:337-310-8500
Practice Address - Fax:888-241-3028
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07510F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist