Provider Demographics
NPI:1972837698
Name:REGALA, JANICE (PT)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:REGALA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 MELROSE COTTAGE DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-7451
Mailing Address - Country:US
Mailing Address - Phone:478-342-0426
Mailing Address - Fax:
Practice Address - Street 1:733 PLANTATION ESTATES DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-9116
Practice Address - Country:US
Practice Address - Phone:704-847-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPT100002251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics