Provider Demographics
NPI:1841758406
Name:DREGER, DARRIN ALAN (PTA)
Entity Type:Individual
Prefix:
First Name:DARRIN
Middle Name:ALAN
Last Name:DREGER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3634 VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-1164
Mailing Address - Country:US
Mailing Address - Phone:262-203-0686
Mailing Address - Fax:
Practice Address - Street 1:3634 VERMONT ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-1164
Practice Address - Country:US
Practice Address - Phone:262-203-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-03
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2352-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant