Provider Demographics
NPI:1942008479
Name:SPINE GROUP FYZICAL LLC
Entity type:Organization
Organization Name:SPINE GROUP FYZICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:205-349-9494
Mailing Address - Street 1:198 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7286
Mailing Address - Country:US
Mailing Address - Phone:334-313-8990
Mailing Address - Fax:334-730-0499
Practice Address - Street 1:835 ODUM RD STE 101
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-4111
Practice Address - Country:US
Practice Address - Phone:205-285-8585
Practice Address - Fax:205-285-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty