Provider Demographics
NPI:1245795475
Name:PERFORMANCE AND REGENERATIVE MEDICINE OF PENSACOLA PA
Entity Type:Organization
Organization Name:PERFORMANCE AND REGENERATIVE MEDICINE OF PENSACOLA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-460-8727
Mailing Address - Street 1:201 S A ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-5554
Mailing Address - Country:US
Mailing Address - Phone:850-460-8727
Mailing Address - Fax:850-460-8725
Practice Address - Street 1:201 S A ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5554
Practice Address - Country:US
Practice Address - Phone:850-460-8727
Practice Address - Fax:850-460-8725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty