Provider Demographics
NPI:1033509914
Name:DYNAPEAK FITNESS AND PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:DYNAPEAK FITNESS AND PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRICCA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-372-5735
Mailing Address - Street 1:116 S HI LUSI AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3025
Mailing Address - Country:US
Mailing Address - Phone:847-372-5735
Mailing Address - Fax:
Practice Address - Street 1:116 S HI LUSI AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3025
Practice Address - Country:US
Practice Address - Phone:847-372-5735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009748261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy