MEDICARE: REGENERATIVE MEDICAL THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	OS5873	FL

General Provider Information

NPI Number	:	1104169242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENERATIVE MEDICAL THERAPY INC

Provider Business Mailing Address
First Line	:	16050 S TAMIAMI TRL STE 109
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4243
Country	:	US
Telephone Number	:	239-243-8823
Fax Number	:	239-437-1451

Provider Business Practice Location Address
First Line	:	16050 S TAMIAMI TRL STE 109
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4243
Country	:	US
Telephone Number	:	239-243-8823
Fax Number	:	239-437-1451

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALEXANDER E. RODI JR.
Credential	:	D.O.
Telephone Number	:	239-243-8823

Provider Enumeration Date	:	03/27/2013
Last Update Date	:	03/27/2013

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