Provider Demographics
NPI:1265974208
Name:COBB, REGINA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WAYLAND AVENUE
Mailing Address - Street 2:SUITE #6
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906
Mailing Address - Country:US
Mailing Address - Phone:508-954-2125
Mailing Address - Fax:401-851-1671
Practice Address - Street 1:120 WAYLAND AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4318
Practice Address - Country:US
Practice Address - Phone:508-954-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMT00836172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMT00836OtherMASSAGE THERAPIST