Provider Demographics
NPI:1871505198
Name:REAGOR, ASHLEY CHRISTINE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:CHRISTINE
Last Name:REAGOR
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:CHRISTINE
Other - Last Name:TISDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:2629 W HORIZON RIDGE PKWY
Mailing Address - Street 2:100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2804
Mailing Address - Country:US
Mailing Address - Phone:702-545-0555
Mailing Address - Fax:702-434-8985
Practice Address - Street 1:2629 W HORIZON RIDGE PKWY
Practice Address - Street 2:100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2804
Practice Address - Country:US
Practice Address - Phone:702-545-0555
Practice Address - Fax:702-434-8985
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36885Medicare PIN
NVV102558Medicare PIN