Healthcare Provider Details

I. General information

NPI: 1346017035
Provider Name (Legal Business Name): LIMITLESS REGENERATIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 PLEASANT AVE
LOVES PARK IL
61111-4533
US

IV. Provider business mailing address

5100 BALCONES DRIVE SUITE 100
AUSTIN TX
78731
US

V. Phone/Fax

Practice location:
  • Phone: 346-268-9775
  • Fax:
Mailing address:
  • Phone: 346-268-9775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: BOBBY K THOMAS
Title or Position: CEO
Credential:
Phone: 346-268-9775