Healthcare Provider Details

I. General information

NPI: 1831574912
Provider Name (Legal Business Name): SEAN A REGAN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S MAIN ST
RICHLANDTOWN PA
18955-1048
US

IV. Provider business mailing address

108 SOUTH MAIN STREET
RICHLANDTOWN PA
18955
US

V. Phone/Fax

Practice location:
  • Phone: 267-371-4573
  • Fax:
Mailing address:
  • Phone: 267-371-4573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016361
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT016361
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: