Provider Demographics
NPI:1881926541
Name:REGAL PHYSICAL THERAPY
Entity type:Organization
Organization Name:REGAL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:REINOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-873-6220
Mailing Address - Street 1:9427 CONANT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3689
Mailing Address - Country:US
Mailing Address - Phone:313-873-6220
Mailing Address - Fax:248-941-0562
Practice Address - Street 1:9427 CONANT ST
Practice Address - Street 2:SUITE C
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3689
Practice Address - Country:US
Practice Address - Phone:313-873-6220
Practice Address - Fax:248-941-0562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJR004272332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies