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General NPI Number Information
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NPI Number | 1285140434
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Entity Type | Individual
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Provider Name | STEPHANIE M REAGAN
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Gender | Female
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 12/26/2017
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Provider Practice Location Address
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Address Line | 3440 S JEFFERSON ST
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City | FALLS CHURCH
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State | VA
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Zip | 22041-3145
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Country | US
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Telephone | 703-578-7660
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Fax |
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Provider Business Mailing Address
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Address Line | 482 RIVER BEND RD
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City | GREAT FALLS
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State | VA
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Zip | 22066-4016
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Country | US
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Telephone | 716-870-8041
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT28071
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License Number State | VA
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