Provider Demographics
NPI:1710747951
Name:ASPIRE REGENERATIVE THERAPY CORP
Entity Type:Organization
Organization Name:ASPIRE REGENERATIVE THERAPY CORP
Other - Org Name:ASPIRE REGENERATIVE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KI
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:KROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-977-0070
Mailing Address - Street 1:5937 WHITBY RD # 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2122
Mailing Address - Country:US
Mailing Address - Phone:210-977-0070
Mailing Address - Fax:
Practice Address - Street 1:5937 WHITBY RD # 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-2122
Practice Address - Country:US
Practice Address - Phone:210-977-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty