Provider Demographics
NPI:1831695998
Name:FYZICAL THERAPY & BALANCE CENTER TYLER PLLC
Entity type:Organization
Organization Name:FYZICAL THERAPY & BALANCE CENTER TYLER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-592-5601
Mailing Address - Street 1:1136 E GRANDE BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3982
Mailing Address - Country:US
Mailing Address - Phone:903-592-5601
Mailing Address - Fax:903-595-3304
Practice Address - Street 1:1136 E GRANDE BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3982
Practice Address - Country:US
Practice Address - Phone:903-592-5601
Practice Address - Fax:903-595-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty