Basic Information
| Provider Information | |||||||||
| NPI: | 1205138278 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REAGAN | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1212 GARFIELD AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261013247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048656778 | ||||||||
| FaxNumber: | 3048657400 | ||||||||
| Practice Location | |||||||||
| Address1: | 47 DEPOT STREET | ||||||||
| Address2: | |||||||||
| City: | CHATHAM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245313352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4344320028 | ||||||||
| FaxNumber: | 4344320062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2010 | ||||||||
| LastUpdateDate: | 10/18/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 033284 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 230520638 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.