Healthcare Provider Details

I. General information

NPI: 1588407381
Provider Name (Legal Business Name): REGINE JEAN-LOUIS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 PEACHTREE ST NE STE 1B
ATLANTA GA
30308-7445
US

IV. Provider business mailing address

1925 MONROE DR NE APT 1253
ATLANTA GA
30324-7813
US

V. Phone/Fax

Practice location:
  • Phone: 404-874-3467
  • Fax: 404-874-5858
Mailing address:
  • Phone: 267-475-1960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017153
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: