Provider Demographics
NPI:1225546849
Name:REGENERATIVE MEDSPA PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:REGENERATIVE MEDSPA PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EHREN
Authorized Official - Last Name:DOTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-292-1735
Mailing Address - Street 1:1920 E BELL RD UNIT 1122
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-6287
Mailing Address - Country:US
Mailing Address - Phone:480-292-1735
Mailing Address - Fax:480-383-6516
Practice Address - Street 1:7054 E COCHISE RD STE B100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-4547
Practice Address - Country:US
Practice Address - Phone:480-292-1735
Practice Address - Fax:480-383-6516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty