# REGENERATIVE FOOT & ANKLE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154822369
- **Authorized official:** STEVEN SHANE MOORE (MANAGER)
- **Authorized official phone:** (623) 974-0522

## Contact information

- **Practice address:** 13660 N 94TH DR STE F1, PEORIA, AZ 85381-4232
- **Practice address phone:** (623) 974-0522
- **Mailing address:** 13660 N 94TH DR STE F1, PEORIA, AZ 85381-4232

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 02/22/2018
- **Last updated:** 02/10/2020