Provider Demographics
NPI:1407513666
Name:FYZICAL AUDIOLOGY, LLC
Entity Type:Organization
Organization Name:FYZICAL AUDIOLOGY, LLC
Other - Org Name:FYZICAL AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-870-7090
Mailing Address - Street 1:9070 W CHEYENNE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8935
Mailing Address - Country:US
Mailing Address - Phone:702-818-5000
Mailing Address - Fax:702-818-5001
Practice Address - Street 1:16251 N CLEVELAND AVE STE 4
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-2176
Practice Address - Country:US
Practice Address - Phone:239-731-6222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty