Provider Demographics
NPI:1881602936
Name:REGINIO, REGIN JOHN (PT)
Entity type:Individual
Prefix:MR
First Name:REGIN
Middle Name:JOHN
Last Name:REGINIO
Suffix:
Gender:M
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:P.O. BOX 1750
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-5706
Mailing Address - Country:US
Mailing Address - Phone:870-534-0543
Mailing Address - Fax:870-534-0541
Practice Address - Street 1:2502 W 28TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5054
Practice Address - Country:US
Practice Address - Phone:870-534-0543
Practice Address - Fax:870-534-0541
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W311Medicare PIN