Provider Demographics
NPI:1679214951
Name:MY VIRTUAL PHYSIO, LLC
Entity Type:Organization
Organization Name:MY VIRTUAL PHYSIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:BAYER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CSCS
Authorized Official - Phone:770-362-0854
Mailing Address - Street 1:11 SAN MARCO ST APT 608
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33767-2061
Mailing Address - Country:US
Mailing Address - Phone:770-362-0854
Mailing Address - Fax:813-696-3788
Practice Address - Street 1:3137 WINDLASS CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5850
Practice Address - Country:US
Practice Address - Phone:770-362-0854
Practice Address - Fax:813-696-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty