Provider Demographics
NPI:1144007873
Name:REGAIN PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:REGAIN PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:POULSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:657-218-4560
Mailing Address - Street 1:11360 WARNER AVE STE 249
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4120
Mailing Address - Country:US
Mailing Address - Phone:657-218-4560
Mailing Address - Fax:657-218-4685
Practice Address - Street 1:11360 WARNER AVE STE 249
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4120
Practice Address - Country:US
Practice Address - Phone:657-218-4560
Practice Address - Fax:657-218-4685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty