Healthcare Provider Details

I. General information

NPI: 1033024179
Provider Name (Legal Business Name): REAGAN YATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 W DIAMOND AVE STE 110
GAITHERSBURG MD
20878-1450
US

IV. Provider business mailing address

3901 NATIONAL DR STE 100
BURTONSVILLE MD
20866-1176
US

V. Phone/Fax

Practice location:
  • Phone: 301-232-3684
  • Fax: 301-500-2175
Mailing address:
  • Phone: 301-232-3684
  • Fax: 301-500-2175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30973
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: