Provider Demographics
NPI:1003005612
Name:PHYTCARE LLC
Entity Type:Organization
Organization Name:PHYTCARE LLC
Other - Org Name:NEXTCARE INC SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:STOIMENOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-924-8382
Mailing Address - Street 1:PO BOX 41008
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-1008
Mailing Address - Country:US
Mailing Address - Phone:800-849-5609
Mailing Address - Fax:910-864-9762
Practice Address - Street 1:4100 WAKE FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6227
Practice Address - Country:US
Practice Address - Phone:919-872-3403
Practice Address - Fax:919-872-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty