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General NPI Number Information
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NPI Number | 1811506538
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Entity Type | Organization
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Legal Business Name | REGENERATE ATX PLLC
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 08/01/2020
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Provider Practice Location Address
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Address Line | 11610 FM 2244 RD STE 230
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City | AUSTIN
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State | TX
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Zip | 78738-5457
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Country | US
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Telephone | 512-284-7025
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Fax |
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Provider Business Mailing Address
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Address Line | 11610 FM 2244 RD STE 230
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City | AUSTIN
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State | TX
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Zip | 78738-5457
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Country | US
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Telephone | 512-284-7025
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUSTIN N HOGAN
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Credential | MD
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Telephone | 512-284-7025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083S0010X
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Taxonomy Name | Sports Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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