Healthcare Provider Details

I. General information

NPI: 1073286787
Provider Name (Legal Business Name): REGENESIS ORTHOPEDICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 PASADENA AVE S STE 290
SOUTH PASADENA FL
33707-4517
US

IV. Provider business mailing address

1615 PASADENA AVE S STE 290
SOUTH PASADENA FL
33707-4517
US

V. Phone/Fax

Practice location:
  • Phone: 727-826-0329
  • Fax: 727-202-7193
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW RAGSDELL
Title or Position: PRESIDENT
Credential: DO
Phone: 727-826-0329