Provider Demographics
NPI:1801650262
Name:REGAN, KELSEY JAMES (PTA)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:JAMES
Last Name:REGAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:JAMES
Other - Last Name:LA PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43 WELLSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9385
Mailing Address - Country:US
Mailing Address - Phone:501-733-2419
Mailing Address - Fax:
Practice Address - Street 1:17 BUSINESS PARK DR STE 13
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9295
Practice Address - Country:US
Practice Address - Phone:501-679-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4832225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant