Provider Demographics
NPI:1083003560
Name:DYNAMIC CARE PHYSICAL THERAPY & SPORTS MEDICINE INC
Entity Type:Organization
Organization Name:DYNAMIC CARE PHYSICAL THERAPY & SPORTS MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HESHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-697-7085
Mailing Address - Street 1:49 TRASK AVE
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-5228
Mailing Address - Country:US
Mailing Address - Phone:551-697-7085
Mailing Address - Fax:
Practice Address - Street 1:4801 BROADWAY
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-6516
Practice Address - Country:US
Practice Address - Phone:551-697-7085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy