Healthcare Provider Details

I. General information

NPI: 1750373767
Provider Name (Legal Business Name): SHARON REGAN P. T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LATTIMORE RD SUITE 178
ROCHESTER NY
14620-4159
US

IV. Provider business mailing address

125 LATTIMORE RD SUITE 178
ROCHESTER NY
14620-4159
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-9110
  • Fax: 585-442-9049
Mailing address:
  • Phone: 585-442-9110
  • Fax: 585-442-9049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number018385
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: