Provider Demographics
NPI:1871713990
Name:REGAN, MELANIE A (PT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:REGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 SOUTH BLVD E STE 120
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5624
Mailing Address - Country:US
Mailing Address - Phone:248-267-5650
Mailing Address - Fax:810-743-1099
Practice Address - Street 1:1555 SOUTH BLVD E STE 120
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5624
Practice Address - Country:US
Practice Address - Phone:248-267-5650
Practice Address - Fax:248-267-5637
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010109222251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP45540017Medicare PIN
MIP45530017Medicare PIN