Individual
MR. LARRY JASON REAGOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
29 VISTA BELLA WAY, NEWNAN, GA 30265-6014
(770) 584-0003
Mailing address
29 VISTA BELLA WAY, NEWNAN, GA 30265-6014
(770) 584-0003
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT006894
GA
Other
Enumeration date
02/04/2012
Last updated
10/20/2016
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