Provider Demographics
NPI:1922330570
Name:NOLAN, REGINA MARY (NCTM)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MARY
Last Name:NOLAN
Suffix:
Gender:F
Credentials:NCTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 MAIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2048
Mailing Address - Country:US
Mailing Address - Phone:570-885-6734
Mailing Address - Fax:
Practice Address - Street 1:1418 MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2048
Practice Address - Country:US
Practice Address - Phone:570-885-6734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA567964-08OtherNCBTMB NATIONAL CERTIFICATION INTHERAPEUTIC MASSAGE