Provider Demographics
NPI:1427855261
Name:WAGAR, REGINA MARIE
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:WAGAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07750-1010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 SANGER AVENUE, FORT MONMOUTH
Practice Address - Street 2:RUSSEL HALL, SUITE 125
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07703
Practice Address - Country:US
Practice Address - Phone:732-380-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02319900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist