Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT-25026 | FL |
N | 225100000X | Physical Therapist | PT25026 | FL |
NPI | 1003193871 |
---|---|
Provider Name | Abigail Dunn Regan |
First Address | Melbourne, FL 32940-1111 |
Second Address | Melbourne, FL 32940-1111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2011 |
Last Update Date | 24/05/2021 |