IndividualActive
Reagan Fernley, PTA
NPI 1881459543 · Sports Medicine (Physical Medicine & Rehabilitation) Physician · Homedale, ID
Provider details
- NPI number
- 1881459543
- Entity type
- Individual
- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) PhysicianAllopathic & Osteopathic Physicians
- Credential
- PTA
- Sex
- Female
- Sole proprietor
- No
- License
- 8554 (ID)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
134 E Idaho Ave
Homedale, ID 83628-5003
Phone: (208) 337-3254
Approximate (ZIP-level) locationGet directions
Mailing address
1217 S Benewah St
Nampa, ID 83686-2868
Registry dates
- Enumerated
- 2024-02-20
- Last updated
- 2024-02-20
- Certified
- 2024-02-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.