Provider Demographics
NPI:1316570310
Name:DYNAMIC REHABILITATION CONSULTANTS INC
Entity Type:Organization
Organization Name:DYNAMIC REHABILITATION CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:WITEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-619-3400
Mailing Address - Street 1:2324 DOGWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-7946
Mailing Address - Country:US
Mailing Address - Phone:970-619-3497
Mailing Address - Fax:818-671-2225
Practice Address - Street 1:4401 UNION ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-2800
Practice Address - Country:US
Practice Address - Phone:970-619-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR.0061737OtherMEDICAL LICENSE