Provider Demographics
NPI:1043664626
Name:DYNAMIC MOTION REHAB CENTER
Entity Type:Organization
Organization Name:DYNAMIC MOTION REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-330-4452
Mailing Address - Street 1:12905 SW 42ND ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2905
Mailing Address - Country:US
Mailing Address - Phone:305-330-4452
Mailing Address - Fax:866-550-0475
Practice Address - Street 1:12905 SW 42ND ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2905
Practice Address - Country:US
Practice Address - Phone:305-330-4452
Practice Address - Fax:866-550-0475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center