Healthcare Provider Details

I. General information

NPI: 1255318465
Provider Name (Legal Business Name): LAURA B. REAGAN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MAIN ST STE B
BYRDSTOWN TN
38549-2418
US

IV. Provider business mailing address

PO BOX 368
BYRDSTOWN TN
38549-0368
US

V. Phone/Fax

Practice location:
  • Phone: 931-864-8090
  • Fax: 931-864-8091
Mailing address:
  • Phone: 931-864-8090
  • Fax: 931-864-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0000006366
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: