Organization
REGENERATIVE SPORT SPINE AND SPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PALLAVI R. CHERUKUPALLY MD (OWNER)
(407) 730-5600
Entity
Organization
Contact information
Practice address
10920 MOSS PARK RD STE 218, ORLANDO, FL 32832-6087
(407) 730-5600
Mailing address
10920 MOSS PARK RD STE 218, ORLANDO, FL 32832-6087
(407) 730-5600
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
ME127634
FL
Other
Enumeration date
04/19/2018
Last updated
04/19/2018
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