Provider Demographics
NPI:1821620170
Name:FYZIOTHERAPY
Entity Type:Organization
Organization Name:FYZIOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:386-214-8886
Mailing Address - Street 1:174 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5352
Mailing Address - Country:US
Mailing Address - Phone:407-288-8299
Mailing Address - Fax:
Practice Address - Street 1:174 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5352
Practice Address - Country:US
Practice Address - Phone:407-288-8299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty