Provider Demographics
NPI:1699066092
Name:ATIENZA, REGINALD (DPT)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:ATIENZA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:REGINALD
Other - Middle Name:
Other - Last Name:ATIENZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:21329 BUNKER DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-4324
Mailing Address - Country:US
Mailing Address - Phone:586-533-6658
Mailing Address - Fax:
Practice Address - Street 1:21329 BUNKER DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-4324
Practice Address - Country:US
Practice Address - Phone:586-533-6658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist