Provider Demographics
NPI:1033498696
Name:DYNAMIC REHAB P T PC
Entity Type:Organization
Organization Name:DYNAMIC REHAB P T PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANATOLI
Authorized Official - Middle Name:
Authorized Official - Last Name:YOSHOVAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:973-910-0307
Mailing Address - Street 1:14905 79TH AVE
Mailing Address - Street 2:# 219
Mailing Address - City:KEW GARDENS HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3855
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14905 79TH AVE
Practice Address - Street 2:# 219
Practice Address - City:KEW GARDENS HILLS
Practice Address - State:NY
Practice Address - Zip Code:11367-3855
Practice Address - Country:US
Practice Address - Phone:973-910-0307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty