Provider Demographics
NPI:1841996956
Name:CLS REGEN, PLLC
Entity type:Organization
Organization Name:CLS REGEN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:LEVI
Authorized Official - Last Name:SIETSEMA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:616-283-8785
Mailing Address - Street 1:39 THRUSH GROVE PL
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4042
Mailing Address - Country:US
Mailing Address - Phone:616-283-8785
Mailing Address - Fax:
Practice Address - Street 1:18707 HARDY OAK BLVD STE 445
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4841
Practice Address - Country:US
Practice Address - Phone:616-283-8785
Practice Address - Fax:512-975-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty