Provider Demographics
NPI:1356654461
Name:DYNAMIC REHAB GROUP LLC
Entity Type:Organization
Organization Name:DYNAMIC REHAB GROUP LLC
Other - Org Name:DYNAMIC CHILDREN THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERLA
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-683-7770
Mailing Address - Street 1:300 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2702
Mailing Address - Country:US
Mailing Address - Phone:956-688-5781
Mailing Address - Fax:956-688-6114
Practice Address - Street 1:6201 S CAGE BLVD
Practice Address - Street 2:STE. 3
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5612
Practice Address - Country:US
Practice Address - Phone:956-283-9832
Practice Address - Fax:956-283-9834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-17
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)