Provider Demographics
NPI:1801473699
Name:VITALITY REGENERATIVE MEDICINE
Entity type:Organization
Organization Name:VITALITY REGENERATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-580-7290
Mailing Address - Street 1:2003 CLEMENT ST
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-1047
Mailing Address - Country:US
Mailing Address - Phone:727-580-7290
Mailing Address - Fax:
Practice Address - Street 1:19105 N US HIGHWAY 41 STE 300
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-4206
Practice Address - Country:US
Practice Address - Phone:727-580-7290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty