Provider Demographics
NPI:1215742200
Name:PHYNAI THERAPY GROUP
Entity type:Organization
Organization Name:PHYNAI THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:GARRETT
Authorized Official - Last Name:GREENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, MBA
Authorized Official - Phone:215-435-8392
Mailing Address - Street 1:1107 MANTUA PIKE STE 720
Mailing Address - Street 2:BOX 102
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1107 MANTUA PIKE STE 720
Practice Address - Street 2:#102
Practice Address - City:MANTUA
Practice Address - State:NJ
Practice Address - Zip Code:08051
Practice Address - Country:US
Practice Address - Phone:215-435-8392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty