Provider Demographics
NPI:1275114605
Name:DYNAMIC MOTION REHAB INC
Entity Type:Organization
Organization Name:DYNAMIC MOTION REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:MARCELA
Authorized Official - Last Name:ROLDAN MORA
Authorized Official - Suffix:
Authorized Official - Credentials:ITDS
Authorized Official - Phone:786-312-5827
Mailing Address - Street 1:883 CRYSTAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-1948
Mailing Address - Country:US
Mailing Address - Phone:786-312-5827
Mailing Address - Fax:
Practice Address - Street 1:883 CRYSTAL LAKE DR
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1948
Practice Address - Country:US
Practice Address - Phone:786-312-5827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-17
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty