Healthcare Provider Details

I. General information

NPI: 1669013694
Provider Name (Legal Business Name): FYZIO V, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16112 6TH ST E
REDINGTON BEACH FL
33708-1618
US

IV. Provider business mailing address

16112 6TH ST E
REDINGTON BEACH FL
33708-1618
US

V. Phone/Fax

Practice location:
  • Phone: 727-336-9120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY YOUNG
Title or Position: CO-OWNER
Credential: PT
Phone: 727-409-8889