Provider Demographics
NPI:1962920454
Name:JOINT REGENERATION AND REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:JOINT REGENERATION AND REHABILITATION CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-627-1148
Mailing Address - Street 1:8915 CONROY WINDERMERE RD STE B
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3127
Mailing Address - Country:US
Mailing Address - Phone:407-909-4788
Mailing Address - Fax:407-909-1788
Practice Address - Street 1:9685 LAKE NONA VILLAGE PL STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827
Practice Address - Country:US
Practice Address - Phone:407-627-1148
Practice Address - Fax:407-627-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty