Provider Demographics
NPI:1891381083
Name:REGO-HEINS, JANA K (LMT)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:K
Last Name:REGO-HEINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7888 WHITEOAK LOOP
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845-4165
Mailing Address - Country:US
Mailing Address - Phone:309-258-1173
Mailing Address - Fax:877-952-1366
Practice Address - Street 1:7888 WHITEOAK LOOP
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845-4165
Practice Address - Country:US
Practice Address - Phone:309-258-1173
Practice Address - Fax:877-592-1366
Is Sole Proprietor?:No
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT013281225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist