Provider Demographics
NPI:1871567339
Name:PHYTNESS GROUP, INC.
Entity type:Organization
Organization Name:PHYTNESS GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:214-754-0501
Mailing Address - Street 1:2001 BRYAN ST
Mailing Address - Street 2:SUITE 2110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-3005
Mailing Address - Country:US
Mailing Address - Phone:214-754-0501
Mailing Address - Fax:214-754-0503
Practice Address - Street 1:9310 S EASTERN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-6843
Practice Address - Country:US
Practice Address - Phone:702-880-8882
Practice Address - Fax:702-880-8829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========OtherTIN
NV100933Medicare PIN