Healthcare Provider Details

I. General information

NPI: 1407513666
Provider Name (Legal Business Name): FYZICAL AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16251 N CLEVELAND AVE STE 4
NORTH FORT MYERS FL
33903-2176
US

IV. Provider business mailing address

9070 W CHEYENNE AVE STE 100
LAS VEGAS NV
89129-8935
US

V. Phone/Fax

Practice location:
  • Phone: 239-731-6222
  • Fax:
Mailing address:
  • Phone: 702-818-5000
  • Fax: 702-818-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: BRIAN BELMONT
Title or Position: CEO
Credential:
Phone: 941-227-4122