Basic Information
| Provider Information | |||||||||
| NPI: | 1326046129 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REGINA | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2775 SCHOENERSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108618080 | ||||||||
| FaxNumber: | 6108070366 | ||||||||
| Practice Location | |||||||||
| Address1: | 2775 SCHOENERSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108618080 | ||||||||
| FaxNumber: | 6108070366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 01/30/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT016947 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 50047057 | 01 | KEYSTONE HEALTH CENTRAL | OTHER | 7861566 | 01 | AETNA PPO | OTHER | 2300284000 | 01 | INDEPENDENCE BLUE CROSS | OTHER | 329145 | 01 | HEALTHAMERICA/HEALTHASSUR | OTHER | 1623385 | 01 | HIGHMARK BLUE SHIELD | OTHER | 818341 | 01 | FIRST PRIORITY HEALTH | OTHER | P3288039 | 01 | OXFORD HEALTH PLANS | OTHER | 2300284000 | 01 | KEYSTONE HEALTH EAST | OTHER | 1623385 | 01 | FIRST PRIORITY LIFE INS | OTHER | 2435644 | 01 | UNITED HEALTHCARE | OTHER | 50047057 | 01 | CAPITAL BLUE CROSS | OTHER | 9142884 | 01 | CIGNA HEALTHCARE | OTHER | P00214999 | 01 | MEDICARE RAILROAD | OTHER | 2170522 | 01 | MAMSI | OTHER | 2300284000 | 01 | AMERIHEALTH | OTHER | 47241 | 01 | GEISINGER HEALTH PLAN | OTHER |