Active NPI
Rosalie M Regedanz, PT
- Physical Therapist
- Plymouth, IN
National Provider Identifier
1235111246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05001121A
- Practice address
- 900 W Jefferson St
Plymouth, IN 46563-1634 - Phone
- (574) 936-9600
- Fax
- (574) 936-9612
- NPI assigned
- Nov 16, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05001121A | IN | Primary |
Addresses
Primary practice location
900 W Jefferson St
Plymouth, IN 46563-1634
Mailing address
PO Box 308
Mishawaka, IN 46546-0308
Phone (574) 273-6546
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200332623 | Other | IN | TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235111246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 308",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465460308",
"telephone_number": "574-273-6546",
"fax_number": "574-273-5295"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 W JEFFERSON ST",
"city": "PLYMOUTH",
"state": "IN",
"postal_code": "465631634",
"telephone_number": "574-936-9600",
"fax_number": "574-936-9612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REGEDANZ",
"first_name": "ROSALIE",
"middle_name": "M",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05001121A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "200332623",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.