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General NPI Number Information
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NPI Number | 1295317618
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Entity Type | Organization
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Legal Business Name | TOTAL REGENERATIVE SOLUTIONS
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 2101 PARKS AVE STE 700
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-4160
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Country | US
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Telephone | 818-424-4270
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 PARKS AVE STE 700
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-4160
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Country | US
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Telephone | 818-424-4270
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF BILLING AND COMPLIANCE
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Name | TONYA GILLIAM
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Credential |
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Telephone | 972-632-6877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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