Provider Demographics
NPI:1104169242
Name:REGENERATIVE MEDICAL THERAPY INC
Entity type:Organization
Organization Name:REGENERATIVE MEDICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:E
Authorized Official - Last Name:RODI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:239-243-8823
Mailing Address - Street 1:16050 S TAMIAMI TRL STE 109
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4243
Mailing Address - Country:US
Mailing Address - Phone:239-243-8823
Mailing Address - Fax:239-437-1451
Practice Address - Street 1:16050 S TAMIAMI TRL STE 109
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4243
Practice Address - Country:US
Practice Address - Phone:239-243-8823
Practice Address - Fax:239-437-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5873208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty