Provider Demographics
NPI:1346719234
Name:DYNAMIC MOVEMENT AND RECOVERY
Entity Type:Organization
Organization Name:DYNAMIC MOVEMENT AND RECOVERY
Other - Org Name:DMR MOVE AND RECOVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:VAN GELDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:616-855-0540
Mailing Address - Street 1:5429 NORTHLAND DR NE STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1089
Mailing Address - Country:US
Mailing Address - Phone:616-855-0540
Mailing Address - Fax:616-855-1185
Practice Address - Street 1:5429 NORTHLAND DR NE STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1089
Practice Address - Country:US
Practice Address - Phone:616-855-0540
Practice Address - Fax:616-855-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy