Provider Demographics
NPI:1538428461
Name:REGAIN PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:REGAIN PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHTING
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:585-586-3819
Mailing Address - Street 1:3819 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1336
Mailing Address - Country:US
Mailing Address - Phone:585-586-3819
Mailing Address - Fax:866-463-1081
Practice Address - Street 1:3819 MONROE AVE
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1336
Practice Address - Country:US
Practice Address - Phone:585-586-3819
Practice Address - Fax:866-463-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-12
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026504-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11442154OtherCAQH