1982843454 NPI number — PHYTEX REHABILITATION, LLC

Table of content: (NPI 1982843454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982843454 NPI number — PHYTEX REHABILITATION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYTEX REHABILITATION, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHYTEX WEST UNIVERSITY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982843454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1365 W UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ODESSA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79764-7121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-580-0011
Provider Business Mailing Address Fax Number:
432-580-0044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1365 W UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79764-7121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-580-0011
Provider Business Practice Location Address Fax Number:
432-580-0044
Provider Enumeration Date:
02/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CARLSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
CRAIG
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
432-550-4700

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)