Healthcare Provider Details

I. General information

NPI: 1053068791
Provider Name (Legal Business Name): MELISSA REGAL P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 LUTHER DR
CHAMBERSBURG PA
17202-8131
US

IV. Provider business mailing address

6248 GUITNER RD
GREENCASTLE PA
17225-9738
US

V. Phone/Fax

Practice location:
  • Phone: 855-211-0688
  • Fax:
Mailing address:
  • Phone: 717-552-8293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI002201
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA14444
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: