Provider Demographics
NPI:1205184421
Name:DYNAMIC REHAB
Entity Type:Organization
Organization Name:DYNAMIC REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHAB SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:480-813-7900
Mailing Address - Street 1:2940 E BANNER GATEWAY DR
Mailing Address - Street 2:SUITE 425
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2168
Mailing Address - Country:US
Mailing Address - Phone:480-813-7900
Mailing Address - Fax:480-813-7901
Practice Address - Street 1:2940 E BANNER GATEWAY DR
Practice Address - Street 2:SUITE 425
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2168
Practice Address - Country:US
Practice Address - Phone:480-813-7900
Practice Address - Fax:480-813-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty