Provider Demographics
NPI:1316399751
Name:DYNAMIC THERAPY INSTITUTE INC.
Entity Type:Organization
Organization Name:DYNAMIC THERAPY INSTITUTE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-317-2526
Mailing Address - Street 1:4471 NW 36TH ST STE 214
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7288
Mailing Address - Country:US
Mailing Address - Phone:786-317-2526
Mailing Address - Fax:
Practice Address - Street 1:4471 NW 36TH ST STE 214
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-7288
Practice Address - Country:US
Practice Address - Phone:786-317-2526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5842302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization