# REGENERATIVE PHYSICAL MEDICINE LLC

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

## Provider details

- **NPI number:** 1942923693
- **Authorized official:** TRACY H UNDERDOWN SOLE MBR (OWNER)
- **Authorized official phone:** (570) 772-5362

## Contact information

- **Practice address:** 250 PIERCE ST STE 103, KINGSTON, PA 18704-5149
- **Practice address phone:** (570) 287-1110
- **Practice address fax:** (570) 287-1121
- **Mailing address:** 1111 E 3RD ST, WILLIAMSPORT, PA 17701-5411
- **Mailing address phone:** (570) 772-5362

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/19/2022
- **Last updated:** 09/19/2022