Provider Demographics
NPI:1528680220
Name:FLORIDA INJURY & REGENERATIVE MEDICINE, PLLC
Entity type:Organization
Organization Name:FLORIDA INJURY & REGENERATIVE MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER / AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRT
Authorized Official - Middle Name:W
Authorized Official - Last Name:REPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-831-6290
Mailing Address - Street 1:101 MARKETSIDE AVE # 404-777
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-1541
Mailing Address - Country:US
Mailing Address - Phone:904-481-1111
Mailing Address - Fax:832-442-3800
Practice Address - Street 1:3033 HARTLEY RD STE 6
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6280
Practice Address - Country:US
Practice Address - Phone:190-448-1111
Practice Address - Fax:832-442-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty