Provider Demographics
NPI:1154329464
Name:DYNAMIC PT & REHAB, INC
Entity Type:Organization
Organization Name:DYNAMIC PT & REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:SCHILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:706-781-2875
Mailing Address - Street 1:262 HIGHWAY 515
Mailing Address - Street 2:SUITE C
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3585
Mailing Address - Country:US
Mailing Address - Phone:706-781-2875
Mailing Address - Fax:706-781-2876
Practice Address - Street 1:262 HIGHWAY 515
Practice Address - Street 2:SUITE C
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3585
Practice Address - Country:US
Practice Address - Phone:706-781-2875
Practice Address - Fax:706-781-2876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00803547AMedicaid
GA00803547AMedicaid