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General NPI Number Information
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NPI Number | 1922421908
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Entity Type | Organization
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Legal Business Name | REAGAN REHABILITATION OUTPATIENT THERAPY, LLC
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Dates
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Enumeration Date | 01/28/2014
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 200 W COMMERCIAL ST
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City | LEBANON
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State | MO
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Zip | 65536-3146
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Country | US
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Telephone | 417-718-0712
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1736
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City | LEBANON
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State | MO
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Zip | 65536-1736
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Country | US
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Telephone | 417-718-0712
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Fax |
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Authorized Official
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Title or Position | OWNER/STAFF THERAPIST
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Name | JONATHAN DW REAGAN
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Credential | MPT
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Telephone | 855-786-8782
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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 | 2001015007
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License Number State | MO
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