Healthcare Provider Details

I. General information

NPI: 1366458978
Provider Name (Legal Business Name): REGENETICS HEALTH INSTITUTE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7806 LAKE UNDERHILL RD STE 106
ORLANDO FL
32822-8232
US

IV. Provider business mailing address

8815 CONROY WINDERMERE RD #203
ORLANDO FL
32835-3129
US

V. Phone/Fax

Practice location:
  • Phone: 407-483-4079
  • Fax: 407-572-8642
Mailing address:
  • Phone: 407-483-4079
  • Fax: 407-572-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME82389
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME82389
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME82389
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLOS JOSE PLACER
Title or Position: PHYSICIAN
Credential: MD
Phone: 407-933-4441