Provider Demographics
NPI:1326046129
Name:REGINA, JEREMY LEE (PT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:LEE
Last Name:REGINA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 SCHOENERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7307
Mailing Address - Country:US
Mailing Address - Phone:610-861-8080
Mailing Address - Fax:610-807-0366
Practice Address - Street 1:2775 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7307
Practice Address - Country:US
Practice Address - Phone:610-861-8080
Practice Address - Fax:610-807-0366
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
50047057OtherKEYSTONE HEALTH CENTRAL
7861566OtherAETNA PPO
2300284000OtherINDEPENDENCE BLUE CROSS
329145OtherHEALTHAMERICA/HEALTHASSUR
1623385OtherHIGHMARK BLUE SHIELD
818341OtherFIRST PRIORITY HEALTH
P3288039OtherOXFORD HEALTH PLANS
2300284000OtherKEYSTONE HEALTH EAST
1623385OtherFIRST PRIORITY LIFE INS
2435644OtherUNITED HEALTHCARE
50047057OtherCAPITAL BLUE CROSS
9142884OtherCIGNA HEALTHCARE
P00214999OtherMEDICARE RAILROAD
2170522OtherMAMSI
2300284000OtherAMERIHEALTH
47241OtherGEISINGER HEALTH PLAN
47241OtherGEISINGER HEALTH PLAN