Regan Moomaw, DPT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

Practice address

2611 S Banker St
Effingham, IL 62401-2980

Phone

(217) 358-1456

NPI assigned

May 21, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Regan Mansur Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629763200000",
    "number": "1831764844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 S HAMILTON ST",
            "city": "SULLIVAN",
            "state": "IL",
            "postal_code": "619512103",
            "telephone_number": "217-358-1456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2611 S BANKER ST",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624012980",
            "telephone_number": "217-358-1456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOOMAW",
        "first_name": "REGAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-21",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "rdmPT",
            "affiliation": "N",
            "address_1": "2611 S Banker St",
            "city": "Effingham",
            "state": "IL",
            "country_code": "US",
            "postal_code": "624012980",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "REGAN",
            "last_name": "MANSUR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Trisha Miller, MHP
• Martha T Mioux, PT
• Mommy & Me Boutique, Inc.
• Shantha Matthew Monippallil, M.D
• Amalio Montez
• Diana Lynn Moon, MS, LPC
• Moore Family Stores Inc.
• Scott Moore, DMD
• Jayne A. Morrison, A.P.N.
• Jennifer L Mosier, M.S., L.P.C.

• Orthopedic Physical Therapist in Effingham, IL
• Providers in Effingham, IL by specialty
• Orthopedic Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.