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General NPI Number Information
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NPI Number | 1437848967
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Entity Type | Organization
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Legal Business Name | REGENERATE PHYSICAL THERAPY AND PERFORMANCE
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Dates
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Enumeration Date | 05/02/2023
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 13337 TINING DR
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City | POWAY
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State | CA
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Zip | 92064-1220
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Country | US
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Telephone | 920-941-0136
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 21ST ST STE R
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City | SACRAMENTO
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State | CA
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Zip | 95811-5226
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DANIEL MORTIMER
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Credential |
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Telephone | 920-941-0136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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