# REGENERATIVE PHYSIATRIST PLLC

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

## Provider details

- **NPI number:** 1326713272
- **Authorized official:** DR. MATTHEW G. MICHAELS MD (CEO)
- **Authorized official phone:** (615) 589-6222

## Contact information

- **Practice address:** 1240 MCKEE RD, DOVER, DE 19904-1381
- **Practice address phone:** (302) 672-5800
- **Mailing address:** 9623 PORTOFINO DR, BRENTWOOD, TN 37027-3829
- **Mailing address phone:** (615) 589-6222

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/12/2021
- **Last updated:** 10/09/2022