Provider Demographics
NPI:1457854812
Name:INSTITUTE FOR PHYSICAL AND REGENERATIVE MEDICINE PLLC
Entity Type:Organization
Organization Name:INSTITUTE FOR PHYSICAL AND REGENERATIVE MEDICINE PLLC
Other - Org Name:INSTITUTE FOR PHYSICAL AND REGENERATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DURRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-367-6900
Mailing Address - Street 1:26603 INTERSTATE 45
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1907
Mailing Address - Country:US
Mailing Address - Phone:281-367-6900
Mailing Address - Fax:281-367-6255
Practice Address - Street 1:26603 INTERSTATE 45
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1907
Practice Address - Country:US
Practice Address - Phone:281-367-6900
Practice Address - Fax:281-367-6255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2976111N00000X
2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty