Provider Demographics
NPI:1790334878
Name:FYZIOGYM PHYSICAL THERAPY OF CALIFORNIA CORP
Entity Type:Organization
Organization Name:FYZIOGYM PHYSICAL THERAPY OF CALIFORNIA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:814-881-4717
Mailing Address - Street 1:711 PACIFIC COAST HWY UNIT 323
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5053
Mailing Address - Country:US
Mailing Address - Phone:814-881-4717
Mailing Address - Fax:
Practice Address - Street 1:16331 GOTHARD ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3664
Practice Address - Country:US
Practice Address - Phone:714-690-0385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy