# GENESIS REGENERATIVE & RESTORATIVE MEDICINE,LLC

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

## Provider details

- **NPI number:** 1639861099
- **Authorized official:** MICHAEL SANDBORN MD (PHYSICIAN/OWNER)
- **Authorized official phone:** (386) 866-9091

## Contact information

- **Practice address:** 1893 N CLYDE MORRIS BLVD STE 120, DAYTONA BEACH, FL 32117-5536
- **Practice address phone:** (386) 866-9091
- **Practice address fax:** (904) 813-7156
- **Mailing address:** 1893 N CLYDE MORRIS BLVD STE 120, DAYTONA BEACH, FL 32117-5536
- **Mailing address phone:** (386) 866-9091
- **Mailing address fax:** (904) 813-7156

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/24/2023
- **Last updated:** 04/16/2024