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General NPI Number Information
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NPI Number | 1003415175
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Entity Type | Organization
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Legal Business Name | REGENERATIVE ARTS OF FLORIDA
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Dates
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Enumeration Date | 10/20/2020
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 4015 N ARMENIA AVE
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City | TAMPA
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State | FL
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Zip | 33607-1001
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Country | US
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Telephone | 630-204-1223
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Fax |
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Provider Business Mailing Address
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Address Line | 11916 TREVALLY LOOP APT 311
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City | NEW PORT RICHEY
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State | FL
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Zip | 34655-0054
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Country | US
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Telephone | 630-204-1223
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Fax |
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Authorized Official
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Title or Position | HEALTH CARE ADMINISTRATOR
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Name | JENNIFER FRIEND
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Credential |
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Telephone | 630-204-1223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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