Provider Demographics
NPI:1588967376
Name:REAGIN, PAMELA ANN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:REAGIN
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4397 HWY 53
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548
Mailing Address - Country:US
Mailing Address - Phone:770-314-9365
Mailing Address - Fax:706-658-2836
Practice Address - Street 1:4397 HWY 53
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548
Practice Address - Country:US
Practice Address - Phone:770-314-9365
Practice Address - Fax:706-658-2836
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA LIC MT000431225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist