Provider Demographics
NPI:1104378561
Name:DYNAMIC STRIDES THERAPY INC
Entity Type:Organization
Organization Name:DYNAMIC STRIDES THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSON
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-422-1183
Mailing Address - Street 1:2673 E SAWYER RD
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-7574
Mailing Address - Country:US
Mailing Address - Phone:479-422-1183
Mailing Address - Fax:479-202-8282
Practice Address - Street 1:2673 E SAWYER RD
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-7574
Practice Address - Country:US
Practice Address - Phone:479-422-1183
Practice Address - Fax:479-202-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty