Provider Demographics
NPI:1164911889
Name:REGENERATIVE REPAIR AND RELIEF, PLLC
Entity Type:Organization
Organization Name:REGENERATIVE REPAIR AND RELIEF, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-374-6111
Mailing Address - Street 1:6 N FAZIO WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-2701
Mailing Address - Country:US
Mailing Address - Phone:832-374-6111
Mailing Address - Fax:
Practice Address - Street 1:10857 KUYKENDAHL RD STE 110
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2936
Practice Address - Country:US
Practice Address - Phone:346-220-8063
Practice Address - Fax:832-838-4362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111N00000X
TXM3662208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty