Provider Demographics
NPI:1992392047
Name:CORTEZ, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 OAK FOREST CT
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-0725
Mailing Address - Country:US
Mailing Address - Phone:732-597-3842
Mailing Address - Fax:
Practice Address - Street 1:217 OAK FOREST CT
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-0725
Practice Address - Country:US
Practice Address - Phone:732-597-3854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25397225100000X
NJ40QA01983100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA25397OtherBOARD OF ALLIED HEALTH PROFESSIONALS
MA25397Medicaid
NJ40QA01983100OtherNJ BOARD OF CONSUMER AFFAIRS