Provider Demographics
NPI:1053989616
Name:REGNER, RYAN ANTHONY (PTA)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:ANTHONY
Last Name:REGNER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13315 FOXHALL DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5309
Mailing Address - Country:US
Mailing Address - Phone:240-486-1932
Mailing Address - Fax:
Practice Address - Street 1:13315 FOXHALL DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-5309
Practice Address - Country:US
Practice Address - Phone:240-486-1932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5429225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant