Provider Demographics
NPI:1073030375
Name:DYNAMIC PERFORMANCE AND REHAB, LLC
Entity Type:Organization
Organization Name:DYNAMIC PERFORMANCE AND REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT
Authorized Official - Phone:401-702-0293
Mailing Address - Street 1:12 INDUSTRIAL LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3126
Mailing Address - Country:US
Mailing Address - Phone:401-702-0293
Mailing Address - Fax:
Practice Address - Street 1:12 INDUSTRIAL LN
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3126
Practice Address - Country:US
Practice Address - Phone:401-702-0293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy