Provider Demographics
NPI:1528429487
Name:REGENERATIVE ARTS VA LLC
Entity type:Organization
Organization Name:REGENERATIVE ARTS VA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-238-8646
Mailing Address - Street 1:465 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:N ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-2129
Mailing Address - Country:US
Mailing Address - Phone:508-238-8646
Mailing Address - Fax:
Practice Address - Street 1:1011 CARE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8439
Practice Address - Country:US
Practice Address - Phone:855-734-3678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty