Provider Demographics
NPI:1588407381
Name:JEAN-LOUIS, REGINE (PT)
Entity type:Individual
Prefix:
First Name:REGINE
Middle Name:
Last Name:JEAN-LOUIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 MONROE DR NE APT 1253
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-7813
Mailing Address - Country:US
Mailing Address - Phone:267-475-1960
Mailing Address - Fax:
Practice Address - Street 1:855 PEACHTREE ST NE STE 1B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-7445
Practice Address - Country:US
Practice Address - Phone:404-874-3467
Practice Address - Fax:404-874-5858
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist