Provider Demographics
NPI:1902457716
Name:REGENERATE PLLC
Entity Type:Organization
Organization Name:REGENERATE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-968-4425
Mailing Address - Street 1:800 W HIGHWAY 290 STE 200
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4493
Mailing Address - Country:US
Mailing Address - Phone:512-968-4425
Mailing Address - Fax:512-858-4426
Practice Address - Street 1:800 W HIGHWAY 290 STE 200
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4493
Practice Address - Country:US
Practice Address - Phone:512-968-4425
Practice Address - Fax:512-858-4426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty