Provider Demographics
NPI:1982843454
Name:PHYTEX REHABILITATION, LLC
Entity Type:Organization
Organization Name:PHYTEX REHABILITATION, LLC
Other - Org Name:PHYTEX WEST UNIVERSITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-550-4700
Mailing Address - Street 1:1365 W UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79764-7121
Mailing Address - Country:US
Mailing Address - Phone:432-580-0011
Mailing Address - Fax:432-580-0044
Practice Address - Street 1:1365 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79764-7121
Practice Address - Country:US
Practice Address - Phone:432-580-0011
Practice Address - Fax:432-580-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00X672Medicare UPIN