Provider Demographics
NPI:1952669343
Name:REGAN, LAUREL (ABT)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:REGAN
Suffix:
Gender:F
Credentials:ABT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 PILLSBURY AVE S
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3835
Mailing Address - Country:US
Mailing Address - Phone:952-882-7933
Mailing Address - Fax:
Practice Address - Street 1:12400 PILLSBURY AVE S
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-3835
Practice Address - Country:US
Practice Address - Phone:952-882-7933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist