Healthcare Provider Details

I. General information

NPI: 1104531672
Provider Name (Legal Business Name): CHARLES REAGAN TOAL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15746 JACKSON CREEK PKWY STE B
MONUMENT CO
80132-7183
US

IV. Provider business mailing address

15746 JACKSON CREEK PKWY STE B
MONUMENT CO
80132-7183
US

V. Phone/Fax

Practice location:
  • Phone: 719-481-0899
  • Fax: 719-481-0897
Mailing address:
  • Phone: 719-481-0899
  • Fax: 719-481-0897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61675054
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number305820
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0020907
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: