Provider Demographics
NPI:1376754051
Name:DYNAMIC PHYSICAL AND HAND THERAPY INC
Entity Type:Organization
Organization Name:DYNAMIC PHYSICAL AND HAND THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-987-6851
Mailing Address - Street 1:500 PASEO CAMARILLO
Mailing Address - Street 2:#105
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5900
Mailing Address - Country:US
Mailing Address - Phone:805-987-6851
Mailing Address - Fax:805-987-8045
Practice Address - Street 1:500 PASEO CAMARILLO
Practice Address - Street 2:#105
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5900
Practice Address - Country:US
Practice Address - Phone:805-987-6851
Practice Address - Fax:805-987-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28530261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT28530AMedicare ID - Type Unspecified
CABH667Medicare PIN