MEDICARE: SHAWN MICHAEL REGAN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT 10558	CO
2	225100000X	Physical Therapist	19255	MA

General Provider Information

NPI Number	:	1811223985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN MICHAEL REGAN DPT

Provider Business Mailing Address
First Line	:	600 S 21ST ST
Second Line	:	SUITE 130
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-3762
Country	:	US
Telephone Number	:	719-634-1110
Fax Number	:	719-634-1112

Provider Business Practice Location Address
First Line	:	600 S 21ST ST
Second Line	:	SUITE 130
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-3762
Country	:	US
Telephone Number	:	719-634-1110
Fax Number	:	719-634-1112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2009
Last Update Date	:	07/22/2014

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