Regenerate Physical Therapy & Performance LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

REGENERATE PHYSICAL THERAPY & PERFORMANCE LLC

Practice address

8750 W Campus Circle Dr Room 167
Berrien Springs, MI 49104-0001

Phone

(269) 235-9816

NPI assigned

Sep 10, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Philip Jardine, DPTNPI 1033791496

Title

Physical Therapy

Phone

(269) 235-9816

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Philip Jardine, DPT

  • Physical Therapist
  • Salt Lake City, UT
  • NPI 1033791496
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1659107449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 HAWTHORNE LN",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202911",
            "telephone_number": "269-449-7455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8750 W CAMPUS CIRCLE DR ROOM 167",
            "city": "BERRIEN SPRINGS",
            "state": "MI",
            "postal_code": "491040001",
            "telephone_number": "269-235-9816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENERATE PHYSICAL THERAPY & PERFORMANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-10",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "JARDINE",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_title_or_position": "PHYSICAL THERAPY",
        "authorized_official_telephone_number": "269-235-9816",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Berrien Springs, MI
• Providers in Berrien Springs, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.