Healthcare Provider Details

I. General information

NPI: 1164911889
Provider Name (Legal Business Name): REGENERATIVE REPAIR AND RELIEF, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10857 KUYKENDAHL RD STE 110
THE WOODLANDS TX
77382-2936
US

IV. Provider business mailing address

6 N FAZIO WAY
SPRING TX
77389-2701
US

V. Phone/Fax

Practice location:
  • Phone: 346-220-8063
  • Fax: 832-838-4362
Mailing address:
  • Phone: 832-374-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberM3662
License Number StateTX

VIII. Authorized Official

Name: EDWARD ALAN NASH
Title or Position: PRESIDENT
Credential: MD
Phone: 832-374-6111