Provider Demographics
NPI:1073274981
Name:DYNAMICITY, LLC
Entity Type:Organization
Organization Name:DYNAMICITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EFOSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUOBADIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:312-835-0841
Mailing Address - Street 1:147-20 JAMAICA AVE
Mailing Address - Street 2:FLOOR 2, SUITE A
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435
Mailing Address - Country:US
Mailing Address - Phone:312-835-0841
Mailing Address - Fax:
Practice Address - Street 1:147-20 JAMAICA AVE
Practice Address - Street 2:FLOOR 2, SUITE A
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435
Practice Address - Country:US
Practice Address - Phone:312-835-0841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-03
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy