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General NPI Number Information
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NPI Number | 1063817781
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Entity Type | Organization
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Legal Business Name | REGENT THERAPY L.L.C.
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 4215 YANCEYVILLE RD APT C
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City | BROWNS SUMMIT
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State | NC
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Zip | 27214-8901
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Country | US
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Telephone | 716-550-0638
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Fax |
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Provider Business Mailing Address
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Address Line | 4215 YANCEYVILLE RD APT C
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City | BROWNS SUMMIT
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State | NC
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Zip | 27214-8901
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER MICHAEL JOHNSON
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Credential | DPT
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Telephone | 716-550-0638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | P14517
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License Number State | NC
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