Provider Demographics
NPI:1952021891
Name:PHYSICAL EVIDENCE REGEN, LLC
Entity Type:Organization
Organization Name:PHYSICAL EVIDENCE REGEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-674-1217
Mailing Address - Street 1:7035 BERACASA WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3454
Mailing Address - Country:US
Mailing Address - Phone:561-674-1217
Mailing Address - Fax:561-287-6556
Practice Address - Street 1:7035 BERACASA WAY STE 103
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3454
Practice Address - Country:US
Practice Address - Phone:561-674-1217
Practice Address - Fax:561-287-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty