Provider Demographics
NPI:1548674393
Name:REGINA HAGSTRAND PT, PLLC
Entity type:Organization
Organization Name:REGINA HAGSTRAND PT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGSTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:518-371-9572
Mailing Address - Street 1:246 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148-1649
Mailing Address - Country:US
Mailing Address - Phone:518-371-9572
Mailing Address - Fax:518-373-2063
Practice Address - Street 1:246 RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:REXFORD
Practice Address - State:NY
Practice Address - Zip Code:12148-1649
Practice Address - Country:US
Practice Address - Phone:518-371-9572
Practice Address - Fax:518-373-2063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY39046BMedicare PIN