Provider Demographics
NPI:1265974356
Name:CHRISTIE, REGAN
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CLYDE ROAD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4558
Mailing Address - Country:US
Mailing Address - Phone:848-216-3163
Mailing Address - Fax:
Practice Address - Street 1:1 CLYDE RD STE 101
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3493
Practice Address - Country:US
Practice Address - Phone:848-216-3163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02068400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist