Provider Demographics
NPI:1134217698
Name:REAGAN, JONATHAN DOUGLAS WAYNE (MPT)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:DOUGLAS WAYNE
Last Name:REAGAN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1736
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536
Mailing Address - Country:US
Mailing Address - Phone:417-718-0712
Mailing Address - Fax:
Practice Address - Street 1:19513 ROUTE 66
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:MO
Practice Address - Zip Code:65722-7150
Practice Address - Country:US
Practice Address - Phone:417-718-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001015007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist