Provider Demographics
NPI:1235261736
Name:DYNAMIC PHYSICAL THERAPY & REHABILITATION, P.C.
Entity Type:Organization
Organization Name:DYNAMIC PHYSICAL THERAPY & REHABILITATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-618-1372
Mailing Address - Street 1:8 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2018
Mailing Address - Country:US
Mailing Address - Phone:203-618-1372
Mailing Address - Fax:203-618-1370
Practice Address - Street 1:2550 WEBB AVE
Practice Address - Street 2:11TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3930
Practice Address - Country:US
Practice Address - Phone:718-410-1302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0158672251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ1W8J1Medicare ID - Type UnspecifiedP.T. PRACTICE