Provider Demographics
NPI:1811506538
Name:REGENERATE ATX PLLC
Entity type:Organization
Organization Name:REGENERATE ATX PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-284-7025
Mailing Address - Street 1:11610 FM 2244 RD STE 230
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5457
Mailing Address - Country:US
Mailing Address - Phone:512-284-7025
Mailing Address - Fax:
Practice Address - Street 1:11610 FM 2244 RD STE 230
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-5457
Practice Address - Country:US
Practice Address - Phone:512-284-7025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports MedicineGroup - Multi-Specialty