Healthcare Provider Details

I. General information

NPI: 1457328056
Provider Name (Legal Business Name): REGINA C HAGSTRAND P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 RIVERVIEW RD
REXFORD NY
12148-1649
US

IV. Provider business mailing address

246 RIVERVIEW RD
REXFORD NY
12148-1649
US

V. Phone/Fax

Practice location:
  • Phone: 518-371-9572
  • Fax: 518-373-2063
Mailing address:
  • Phone: 518-371-9572
  • Fax: 518-776-1064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0041571
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: