Provider Demographics
NPI:1720053747
Name:SOBOJINSKI, REGINA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:SOBOJINSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 S WASHBURN ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-8051
Mailing Address - Country:US
Mailing Address - Phone:920-235-8966
Mailing Address - Fax:920-235-1526
Practice Address - Street 1:909 S WASHBURN ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-8051
Practice Address - Country:US
Practice Address - Phone:920-235-8966
Practice Address - Fax:920-235-1526
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3887-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40171400Medicaid
WI000086635 0002Medicare ID - Type Unspecified