Healthcare Provider Details

I. General information

NPI: 1598681108
Provider Name (Legal Business Name): REJUVENATE ORTHOPEDIC & REGENERATIVE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 3RD ST STE 103
ROCKLEDGE FL
32955-5788
US

IV. Provider business mailing address

6420 3RD ST STE 103
ROCKLEDGE FL
32955-5788
US

V. Phone/Fax

Practice location:
  • Phone: 321-335-7833
  • Fax:
Mailing address:
  • Phone: 321-335-7833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DAVID HARRIS
Title or Position: OWNER
Credential: PA-C
Phone: 321-652-5929