Healthcare Provider Details

I. General information

NPI: 1336079060
Provider Name (Legal Business Name): FYZIOGYM, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 25TH CT E UNIT 106
SARASOTA FL
34243-2815
US

IV. Provider business mailing address

8692 MILESTONE DR
SARASOTA FL
34238-3901
US

V. Phone/Fax

Practice location:
  • Phone: 941-337-0246
  • Fax:
Mailing address:
  • Phone: 814-881-4717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LYNEIL CJ MITCHELL
Title or Position: OWNER
Credential: DPT
Phone: 941-337-0246