Provider Demographics
NPI:1750899415
Name:RODIG, REGAN M (LMT)
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:M
Last Name:RODIG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 WHISPERING SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-2301
Mailing Address - Country:US
Mailing Address - Phone:907-441-7623
Mailing Address - Fax:
Practice Address - Street 1:121 W FIREWEED LN
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2053
Practice Address - Country:US
Practice Address - Phone:907-222-6887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101390225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist