Provider Demographics
NPI:1285737361
Name:REGER, CORTLAND
Entity type:Individual
Prefix:
First Name:CORTLAND
Middle Name:
Last Name:REGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 242131
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-2131
Mailing Address - Country:US
Mailing Address - Phone:907-677-9112
Mailing Address - Fax:907-677-9121
Practice Address - Street 1:510 W TUDOR RD
Practice Address - Street 2:SUITE 10
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6649
Practice Address - Country:US
Practice Address - Phone:907-677-9112
Practice Address - Fax:907-677-9121
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1380OtherLICENSE #