Provider Demographics
NPI:1770891996
Name:PHYTEX REHABILITATION, LLC
Entity type:Organization
Organization Name:PHYTEX REHABILITATION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:3404 N MIDLAND DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-4600
Mailing Address - Country:US
Mailing Address - Phone:432-617-3110
Mailing Address - Fax:432-617-3112
Practice Address - Street 1:4409 W WADLEY AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5328
Practice Address - Country:US
Practice Address - Phone:432-617-3110
Practice Address - Fax:432-617-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty