Provider Demographics
NPI:1093901464
Name:PHYZMED
Entity Type:Organization
Organization Name:PHYZMED
Other - Org Name:PHYZMED REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-296-9090
Mailing Address - Street 1:6817 SOUTHPOINT PKWY
Mailing Address - Street 2:SUITE 604
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6282
Mailing Address - Country:US
Mailing Address - Phone:904-296-9090
Mailing Address - Fax:904-296-9050
Practice Address - Street 1:9550 BAYMEADOWS RD
Practice Address - Street 2:SUITE 9
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0710
Practice Address - Country:US
Practice Address - Phone:904-739-7398
Practice Address - Fax:904-739-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty