Provider Demographics
NPI:1265024848
Name:REGENERATE THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:REGENERATE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIR
Authorized Official - Suffix:III
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:312-857-8180
Mailing Address - Street 1:17200 OAK PARK AVE UNIT 306
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3639
Mailing Address - Country:US
Mailing Address - Phone:312-857-8180
Mailing Address - Fax:
Practice Address - Street 1:6301 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443
Practice Address - Country:US
Practice Address - Phone:815-905-1172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy