Provider Demographics
NPI:1316016801
Name:DYNAMIC THERAPY INC
Entity Type:Organization
Organization Name:DYNAMIC THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:CHUA
Authorized Official - Last Name:OCAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:863-648-2333
Mailing Address - Street 1:4734 EXPLORATION AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-3319
Mailing Address - Country:US
Mailing Address - Phone:863-648-2333
Mailing Address - Fax:863-648-2888
Practice Address - Street 1:4734 EXPLORATION AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-3319
Practice Address - Country:US
Practice Address - Phone:863-648-2333
Practice Address - Fax:863-648-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8050OtherBCBS PROVIDER NUMBER
FLY8050ZMedicare ID - Type UnspecifiedPROVIDER NUMER
FLE6955ZMedicare ID - Type UnspecifiedPROVIDER NUMBER