Healthcare Provider Details

I. General information

NPI: 1851917801
Provider Name (Legal Business Name): FYZICAL CORPUS CHRISTI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 AIRLINE RD STE E
CORPUS CHRISTI TX
78414-3571
US

IV. Provider business mailing address

4510 GRAND LAKE DR
CORPUS CHRISTI TX
78413-5267
US

V. Phone/Fax

Practice location:
  • Phone: 361-334-1033
  • Fax:
Mailing address:
  • Phone: 210-269-0242
  • 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: MS. DIANA M LOPEZ
Title or Position: OWNER, OPERATIONS MANAGER
Credential:
Phone: 210-269-0242