OrganizationActive
Alliance Regenerative and Performance Medicine, PLLC
NPI 1104418292 · Sports Medicine (Family Medicine) Physician · St Petersburg, FL
Provider details
- NPI number
- 1104418292
- Entity type
- Organization
- Primary specialty
- Sports Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- John Broussard, Owner(727) 258-7224
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
111 2nd Ave Ne Ste 1401
St Petersburg, FL 33701-3480
Phone: (727) 258-7224
Approximate (ZIP-level) locationGet directions
Mailing address
111 2nd Ave Ne Ste 1401
St Petersburg, FL 33701-3480
Registry dates
- Enumerated
- 2021-02-09
- Last updated
- 2021-02-09
- Certified
- 2021-02-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.