Provider Demographics
NPI:1902496318
Name:PHYZIOPRO LLC
Entity Type:Organization
Organization Name:PHYZIOPRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHROUS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-303-5630
Mailing Address - Street 1:111 SHAMROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-1630
Mailing Address - Country:US
Mailing Address - Phone:941-303-5630
Mailing Address - Fax:941-303-5630
Practice Address - Street 1:111 SHAMROCK BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-1630
Practice Address - Country:US
Practice Address - Phone:941-303-5630
Practice Address - Fax:941-303-5630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty