Provider Demographics
NPI:1326294349
Name:DYNAMIC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:DYNAMIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-876-9186
Mailing Address - Street 1:440 E ROOSEVELT RD
Mailing Address - Street 2:UNIT 104
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-3902
Mailing Address - Country:US
Mailing Address - Phone:630-876-9186
Mailing Address - Fax:630-876-9187
Practice Address - Street 1:25 N CASS AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1601
Practice Address - Country:US
Practice Address - Phone:630-615-9170
Practice Address - Fax:630-493-0995
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DYNAMIC PHYSICAL THERAPY MANAGEMENT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.008757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty