Provider Demographics
NPI:1033972062
Name:DYNAMIC ORTHOPEDIC CENTERS OF TENNESSEE
Entity Type:Organization
Organization Name:DYNAMIC ORTHOPEDIC CENTERS OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-482-3501
Mailing Address - Street 1:PO BOX 773101
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33077-3101
Mailing Address - Country:US
Mailing Address - Phone:833-303-0362
Mailing Address - Fax:833-466-1400
Practice Address - Street 1:1775 PYRAMID PL STE 112
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-1717
Practice Address - Country:US
Practice Address - Phone:833-303-0362
Practice Address - Fax:833-466-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies