Provider Demographics
NPI:1205230026
Name:SWANSON, REGINA MARIE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MARIE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:MARIE
Other - Last Name:SCARSELLETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1325 S KIHEI RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8179
Mailing Address - Country:US
Mailing Address - Phone:808-874-6972
Mailing Address - Fax:808-874-6973
Practice Address - Street 1:1325 S KIHEI RD
Practice Address - Street 2:SUITE 110
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8179
Practice Address - Country:US
Practice Address - Phone:808-874-6972
Practice Address - Fax:808-874-6973
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist