Healthcare Provider Details

I. General information

NPI: 1053989616
Provider Name (Legal Business Name): RYAN ANTHONY REGNER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13315 FOXHALL DR
SILVER SPRING MD
20906-5309
US

IV. Provider business mailing address

13315 FOXHALL DR
SILVER SPRING MD
20906-5309
US

V. Phone/Fax

Practice location:
  • Phone: 240-486-1932
  • Fax:
Mailing address:
  • Phone: 240-486-1932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA5429
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: