NPIMap

Organization Active NPI

Phoenix Vitality, LLC

  • General Practice Physician
  • Leipsic, OH
National Provider Identifier
1104776939
Registry record updated Jan 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
PHOENIX VITALITY, LLC
Practice address
603 E Main St
Leipsic, OH 45856-1438
Phone
(419) 957-9737
NPI assigned
Jan 31, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stephanie Lynn Rodriguez, CNPNPI 1235647033
Title
Nurse Practitioner
Phone
(419) 957-0631

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

603 E Main St
Leipsic, OH 45856-1438

Mailing address

603 E Main St
Leipsic, OH 45856-1438
Phone (419) 957-9737

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1769817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769817600000",
    "number": "1104776939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 E MAIN ST",
            "city": "LEIPSIC",
            "state": "OH",
            "postal_code": "458561438",
            "telephone_number": "419-957-9737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 E MAIN ST",
            "city": "LEIPSIC",
            "state": "OH",
            "postal_code": "458561438",
            "telephone_number": "419-957-9737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX VITALITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-31",
        "last_updated": "2026-01-31",
        "certification_date": "2026-01-31",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "419-957-0631",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leipsic, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.