MEDICARE: DR. GIOVANNI REGALADO PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070028567	IL

General Provider Information

NPI Number	:	1104655539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GIOVANNI REGALADO PT, DPT

Provider Business Mailing Address
First Line	:	112 HERFF RD STE 310
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78006-2750
Country	:	US
Telephone Number	:	830-431-9660
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 HERFF RD STE 310
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78006-2750
Country	:	US
Telephone Number	:	830-431-9660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2024
Last Update Date	:	04/21/2026

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