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General NPI Number Information
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NPI Number | 1962689422
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Entity Type | Organization
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Legal Business Name | DR. MICHAEL FLYZIK DPT,OCS,PC
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 1621 E SOUTHLAKE BLVD SUITE 300
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6448
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Country | US
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Telephone | 817-416-1444
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Fax | 817-416-0060
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Provider Business Mailing Address
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Address Line | 1621 E SOUTHLAKE BLVD SUITE 300
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6448
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Country | US
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Telephone | 817-416-1444
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Fax | 817-416-0060
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. MICHAEL FLYZIK
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Credential | DPT,OCS
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Telephone | 817-416-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1082675
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License Number State | TX
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