Provider Demographics
NPI:1275263139
Name:JOINT REGENERATION OF FLORIDA LLC
Entity Type:Organization
Organization Name:JOINT REGENERATION OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KRISTYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:135-567-4408
Mailing Address - Street 1:120 STATE ST E STE 104
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3647
Mailing Address - Country:US
Mailing Address - Phone:813-556-7440
Mailing Address - Fax:
Practice Address - Street 1:120 STATE ST E STE 104
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3647
Practice Address - Country:US
Practice Address - Phone:813-556-7440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty