Provider Demographics
NPI:1952012866
Name:REGER, MADISON MICHAEL (ATC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:MICHAEL
Last Name:REGER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:MICHAEL
Other - Last Name:PRESTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:3200 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-3599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-3599
Practice Address - Country:US
Practice Address - Phone:724-561-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARTO0002452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer