Provider Demographics
NPI:1891301842
Name:GRIFFIN, REGINA ANN (LMT)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:ANN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:REGINA
Other - Middle Name:ANN
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1314 E LAS OLAS BLVD # 1655
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2334
Mailing Address - Country:US
Mailing Address - Phone:267-939-5985
Mailing Address - Fax:
Practice Address - Street 1:721 WEST BROWN STREET
Practice Address - Street 2:APT 1R
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123
Practice Address - Country:US
Practice Address - Phone:267-939-5985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA95383225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist