Provider Demographics
NPI:1669917787
Name:WHITE, REGAN COLLEEN (PT, DPT, ATC, CLT)
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:COLLEEN
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT, DPT, ATC, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-1816
Mailing Address - Country:US
Mailing Address - Phone:574-583-5590
Mailing Address - Fax:
Practice Address - Street 1:1002 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-1816
Practice Address - Country:US
Practice Address - Phone:574-583-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32257225100000X
VA2305210830225100000X
IN05013720A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist