Provider Demographics
NPI:1003969908
Name:DYNAMIC PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:DYNAMIC PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAJE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:937-237-0400
Mailing Address - Street 1:4760 FISHBURG RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-5460
Mailing Address - Country:US
Mailing Address - Phone:937-237-0400
Mailing Address - Fax:937-885-7365
Practice Address - Street 1:4760 FISHBURG RD
Practice Address - Street 2:SUITE C
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-5460
Practice Address - Country:US
Practice Address - Phone:937-237-0400
Practice Address - Fax:937-885-7365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3227261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy