Provider Demographics
NPI:1366937591
Name:PHYTEX REHABILITATION, LLC
Entity type:Organization
Organization Name:PHYTEX REHABILITATION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
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 1:2525 N GRANDVIEW AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-1621
Mailing Address - Country:US
Mailing Address - Phone:346-241-0450
Mailing Address - Fax:281-605-6742
Practice Address - Street 1:7036B FM 1960 RD E
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2704
Practice Address - Country:US
Practice Address - Phone:346-241-0450
Practice Address - Fax:281-605-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
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