# REGENESYS PHYSICAL MEDICINE PLLC

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

## Provider details

- **NPI number:** 1518467059
- **Authorized official:** BRANDON B WILSON DC (OWNER)
- **Authorized official phone:** (972) 712-5556

## Contact information

- **Practice address:** 425 OLD NEWMAN RD STE 100, FRISCO, TX 75036-4773
- **Practice address phone:** (972) 712-5556
- **Practice address fax:** (972) 712-5579
- **Mailing address:** 425 OLD NEWMAN RD STE 100, FRISCO, TX 75036-4773
- **Mailing address phone:** (972) 712-5556
- **Mailing address fax:** (972) 712-5579

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | TX | Yes |

## Other

- **Enumeration date:** 02/20/2018
- **Last updated:** 01/03/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 10828 | LICENSE | TX |