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General NPI Number Information
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NPI Number | 1326760919
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Entity Type | Individual
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Provider Name | REGINA M TART LMT
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Gender | Female
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 640 BELLE TERRE RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1936
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Country | US
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Telephone | 631-828-5361
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Fax |
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Provider Business Mailing Address
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Address Line | 14 CHURCH LN
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City | MIDDLE ISLAND
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State | NY
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Zip | 11953-1706
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Country | US
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Telephone | 631-905-8558
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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