Provider Demographics
NPI:1902226517
Name:REGAN, BRIDGET GRACE (PT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:GRACE
Last Name:REGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:KOLEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2781 EAGLE VISTA CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3175
Mailing Address - Country:US
Mailing Address - Phone:832-386-5558
Mailing Address - Fax:
Practice Address - Street 1:2781 EAGLE VISTA CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3175
Practice Address - Country:US
Practice Address - Phone:832-386-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist