Provider Demographics
NPI:1861604019
Name:REJUVENATIONS INCORPORATED
Entity type:Organization
Organization Name:REJUVENATIONS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:REPICE
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:239-530-3040
Mailing Address - Street 1:1575 PINE RIDGE RD
Mailing Address - Street 2:SUITE 6 & 7
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2107
Mailing Address - Country:US
Mailing Address - Phone:239-530-3040
Mailing Address - Fax:239-530-3050
Practice Address - Street 1:1715 HERITAGE TRAIL
Practice Address - Street 2:SUITE 203
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112
Practice Address - Country:US
Practice Address - Phone:239-530-3040
Practice Address - Fax:239-530-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12089225X00000X
FLPT8896225100000X
FLCH8620111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89613BMedicare ID - Type UnspecifiedMEDICARE ID NUMBER
FLK8856Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FLU48983Medicare UPIN