Provider Demographics
NPI:1154604429
Name:MANION, REGINA M (REGINA MANION)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:M
Last Name:MANION
Suffix:
Gender:F
Credentials:REGINA MANION
Other - Prefix:MS
Other - First Name:REGINA
Other - Middle Name:M
Other - Last Name:FANELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGINA MANION
Mailing Address - Street 1:4750 N CENTRAL AVE
Mailing Address - Street 2:APT. 11C
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1732
Mailing Address - Country:US
Mailing Address - Phone:602-264-4159
Mailing Address - Fax:
Practice Address - Street 1:4750 N CENTRAL AVE
Practice Address - Street 2:APT. 11C
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1732
Practice Address - Country:US
Practice Address - Phone:602-264-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9225A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant