Provider Demographics
NPI:1962689422
Name:DR. MICHAEL FLYZIK DPT,OCS,PC
Entity Type:Organization
Organization Name:DR. MICHAEL FLYZIK DPT,OCS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYZIK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT,OCS
Authorized Official - Phone:817-416-1444
Mailing Address - Street 1:1621 E SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6448
Mailing Address - Country:US
Mailing Address - Phone:817-416-1444
Mailing Address - Fax:817-416-0060
Practice Address - Street 1:1621 E SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6448
Practice Address - Country:US
Practice Address - Phone:817-416-1444
Practice Address - Fax:817-416-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1082675261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00820ZMedicare PIN