Healthcare Provider Details

I. General information

NPI: 1235111246
Provider Name (Legal Business Name): ROSALIE M REGEDANZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W JEFFERSON ST
PLYMOUTH IN
46563-1634
US

IV. Provider business mailing address

PO BOX 308
MISHAWAKA IN
46546-0308
US

V. Phone/Fax

Practice location:
  • Phone: 574-936-9600
  • Fax: 574-936-9612
Mailing address:
  • Phone: 574-273-6546
  • Fax: 574-273-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05001121A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: