Provider Demographics
NPI:1770812521
Name:REGINA, MICHAEL THOMAS (DPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:REGINA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:17660 UNION TPKE
Mailing Address - Street 2:195
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1526
Mailing Address - Country:US
Mailing Address - Phone:718-820-9300
Mailing Address - Fax:718-820-9382
Practice Address - Street 1:17660 UNION TPKE
Practice Address - Street 2:195
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1526
Practice Address - Country:US
Practice Address - Phone:718-820-9300
Practice Address - Fax:718-820-9382
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY620321972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic