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Organization
REGENERATIVE PHYSICAL MEDICINE LLC
Active
Organization
REGENERATIVE PHYSICAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY H UNDERDOWN SOLE MBR (OWNER)
(570) 772-5362
Entity
Organization
Contact information
Practice address
250 PIERCE ST STE 103, KINGSTON, PA 18704-5149
(570) 287-1110
(570) 287-1121
Mailing address
1111 E 3RD ST, WILLIAMSPORT, PA 17701-5411
(570) 772-5362
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
09/19/2022
Last updated
09/19/2022
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