Provider Demographics
NPI:1922210814
Name:BRUNTON, REGINA HELENA (OTR)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:HELENA
Last Name:BRUNTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 1271
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-1271
Mailing Address - Country:US
Mailing Address - Phone:972-786-3720
Mailing Address - Fax:
Practice Address - Street 1:1922 CASTLE DRIVE
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040
Practice Address - Country:US
Practice Address - Phone:972-494-1471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2053480225200000X
TX111585225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist